MEDICARE: LILY N ENAYATI MD

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	207R00000X	Internal Medicine Physician	G078301	CA

General Provider Information

NPI Number	:	1447322847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILY N ENAYATI MD

Provider Business Mailing Address
First Line	:	1 BAYWOOD AVE STE 10
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94402-1537
Country	:	US
Telephone Number	:	650-342-2974
Fax Number	:	650-347-5404

Provider Business Practice Location Address
First Line	:	1 BAYWOOD AVE STE 10
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94402-1537
Country	:	US
Telephone Number	:	650-342-2974
Fax Number	:	650-347-5404

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

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	11/16/2021

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