Physician Nutraceutical Research, Inc

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

300189AP Issued in CA

Legal business name

PHYSICIAN NUTRACEUTICAL RESEARCH, INC

Practice address

140 Avenida Algodon
#A, B & C
San Clemente, CA 92672-4182

Phone

(888) 508-3371

Fax

(949) 481-7063

NPI assigned

Jan 26, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Willa Ann Lilly, D.O.

Title

Executive Director

Phone

(888) 508-3371

Specialties & licenses 3

Addresses

Other names 1

• Dr. Willa's House Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1296000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296000000000",
    "number": "1154627925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 AVENIDA ALGODON",
            "address_2": "#A, B & C",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926724182",
            "telephone_number": "888-508-3371",
            "fax_number": "949-481-7063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 AVENIDA ALGODON",
            "address_2": "#A, B & C",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926724182",
            "telephone_number": "888-508-3371",
            "fax_number": "949-481-7063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIAN NUTRACEUTICAL RESEARCH, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-26",
        "last_updated": "2011-01-26",
        "status": "A",
        "authorized_official_last_name": "LILLY",
        "authorized_official_first_name": "WILLA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "888-508-3371",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "300189AP",
            "primary": true
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "300189BP",
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "300189CP",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Willa's House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Deborah Phillips
• Melissa Renee Phillips, M.A., CCC-SLP
• Richard Steven Phillips, DDS
• Riley Makenna Phillips, CF-SLP
• PHS San Clemente, Inc.
• Briana Pica, PT, DPT
• Emelia Rose Piccininni, OTD, OTR/L
• Jay Pichika
• Ashton Pickle, DPT
• Kenneth B. Pierce, D.O.

• Substance Abuse Rehabilitation Facility in San Clemente, CA
• Providers in San Clemente, CA by specialty
• Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.