1104684612 NPI number — PEDIATRIC WELLNESS PARTNERS, A PROFESSIONAL NURSING CORPORATION

Table of content: LILIA BUNICK LPC, NCC (NPI 1336520949)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104684612 NPI number — PEDIATRIC WELLNESS PARTNERS, A PROFESSIONAL NURSING CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC WELLNESS PARTNERS, A PROFESSIONAL NURSING CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104684612
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
995 MARSH RD STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDWOOD CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94063-4441
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
919 FREMONT AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ALTOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94024-6045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-941-2300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/08/2024

Additional Information

Authorized Official

Authorized Official Last Name:
ERLICH
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
Authorized Official Title or Position:
FOUNDER/CEO
Authorized Official Telephone Number:
650-910-4708

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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