Organization
GLOBAL NUTRACEUTICALS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLA LILLY DO (OWNER)
(949) 366-0432
Entity
Organization
Contact information
Practice address
140 AVENIDA ALGODON, UNIT B, SAN CLEMENTE, CA 92672-4182
(949) 366-0432
(949) 542-7020
Mailing address
140 AVENIDA ALGODON, UNIT B, SAN CLEMENTE, CA 92672-4182
(949) 366-0432
(949) 542-7020
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
20A4676
CA
Other
Enumeration date
11/21/2011
Last updated
11/21/2011
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