Healthcare Provider Details

I. General information

NPI: 1972136950
Provider Name (Legal Business Name): LIXIANG LI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 04/16/2020
Certification Date: 04/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 WILLOW PASS RD STE 200
CONCORD CA
94520-5823
US

IV. Provider business mailing address

95 MONTE VISTA CT
PLEASANT HILL CA
94523-4235
US

V. Phone/Fax

Practice location:
  • Phone: 925-646-5480
  • Fax: 925-646-5622
Mailing address:
  • Phone: 415-827-0857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number823872
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: