Healthcare Provider Details

I. General information

NPI: 1245600774
Provider Name (Legal Business Name): DENISE T LI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2015
Last Update Date: 09/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3694 HAPPY VALLEY RD
LAFAYETTE CA
94549-3040
US

IV. Provider business mailing address

PO BOX 1452
LAFAYETTE CA
94549-1452
US

V. Phone/Fax

Practice location:
  • Phone: 925-360-5835
  • Fax: 925-462-7258
Mailing address:
  • Phone: 925-360-5835
  • Fax: 925-462-7258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number391756
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95001523
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: