Provider Demographics
NPI:1720668106
Name:TILLES, DANIELA ROBBIANO (LVN)
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:ROBBIANO
Last Name:TILLES
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:DANIELA
Other - Middle Name:ALEJANDRA
Other - Last Name:ROBBIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:6471 MEADOW CREST DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-5575
Mailing Address - Country:US
Mailing Address - Phone:323-253-4303
Mailing Address - Fax:
Practice Address - Street 1:6471 MEADOW CREST DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-5575
Practice Address - Country:US
Practice Address - Phone:323-253-4303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-10
Last Update Date:2021-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN275357311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home