| Iwill Til Imwell Llc | |
|
1252 Clayburn Ln San Jose CA 95121-2610 | |
| (504) 874-5809 | |
| Not Available |
| Full Name | Iwill Til Imwell Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1252 Clayburn Ln, San Jose, California |
| Authorized Official Name and Position | Jillandra Rovaris (CEO) |
| Authorized Official Contact | 5048745809 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Iwill Til Imwell Llc 1252 Clayburn Ln San Jose CA 95121-2610 Ph: (504) 874-5809 | Iwill Til Imwell Llc 1252 Clayburn Ln San Jose CA 95121-2610 Ph: (504) 874-5809 |
| NPI Number | 1871217042 |
|---|---|
| Provider Enumeration Date | 09/30/2022 |
| Last Update Date | 10/25/2022 |
| Certification Date | 10/25/2022 |
| Medicare PECOS PAC ID | 2567838154 |
|---|---|
| Medicare Enrollment ID | O20221024000836 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871217042 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Jillandra Rovaris |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1770104184 PECOS PAC ID: 3476929068 Enrollment ID: I20221024001037 |
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