Basic Information
| Provider Information | |||||||||
| NPI: | 1003014036 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LILLO | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | Y | ||||||||
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| Credential: | CCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3405 S YARROW ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802274965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039738482 | ||||||||
| FaxNumber: | 3039738468 | ||||||||
| Practice Location | |||||||||
| Address1: | 3405 S YARROW ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802274965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039738482 | ||||||||
| FaxNumber: | 3039738468 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2007 | ||||||||
| LastUpdateDate: | 07/11/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 229N00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Anaplastologist |
ID Information
| ID | Type | State | Issuer | Description | 08835233 | 05 | CO | MEDICAID |