Provider Demographics
NPI:1891413332
Name:AMETLLER, LILIAM SIXELA
Entity type:Individual
Prefix:
First Name:LILIAM
Middle Name:SIXELA
Last Name:AMETLLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21666 REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-6440
Mailing Address - Country:US
Mailing Address - Phone:510-688-8166
Mailing Address - Fax:
Practice Address - Street 1:828 S BASCOM AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2651
Practice Address - Country:US
Practice Address - Phone:800-704-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program