MEDICARE: SHIAN LI LUO NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	95013579	CA

General Provider Information

NPI Number	:	1053950881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIAN LI LUO NP

Provider Business Mailing Address
First Line	:	1000 NATIONAL AVE APT 150
Second Line	:
City	:	SAN BRUNO
State	:	CA
Zip	:	94066-2477
Country	:	US
Telephone Number	:	347-301-3336
Fax Number	:

Provider Business Practice Location Address
First Line	:	1828 EL CAMINO REAL STE 405
Second Line	:
City	:	BURLINGAME
State	:	CA
Zip	:	94010-3115
Country	:	US
Telephone Number	:	650-651-7175
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2019
Last Update Date	:	01/16/2020

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