Organization
PHYSICIAN NUTRACEUTICAL RESEARCH, INC
Active
Other names
Dr. Willa's House
Organization subpart
No
Provider details
NPI number
Authorized official
WILLA ANN LILLY D.O. (EXECUTIVE DIRECTOR)
(888) 508-3371
Entity
Organization
Contact information
Practice address
140 AVENIDA ALGODON, #A, B & C, SAN CLEMENTE, CA 92672-4182
(888) 508-3371
(949) 481-7063
Mailing address
140 AVENIDA ALGODON, #A, B & C, SAN CLEMENTE, CA 92672-4182
(888) 508-3371
(949) 481-7063
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
300189AP
CA
324500000X
Substance Abuse Rehabilitation Facility
300189BP
CA
324500000X
Substance Abuse Rehabilitation Facility
300189CP
CA
Other
Enumeration date
01/26/2011
Last updated
01/26/2011
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