Provider Demographics
NPI:1811007172
Name:ATALLA, LILY R (MD)
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:R
Last Name:ATALLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:PO BOX 30220
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90030-0220
Mailing Address - Country:US
Mailing Address - Phone:562-803-0124
Mailing Address - Fax:562-803-5569
Practice Address - Street 1:7601 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-3456
Practice Address - Country:US
Practice Address - Phone:562-803-0124
Practice Address - Fax:562-803-5569
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA497982084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G16264Medicare UPIN
CAWA49798AMedicare ID - Type UnspecifiedPPIN