Healthcare Provider Details

I. General information

NPI: 1952661985
Provider Name (Legal Business Name): IRIS REBECCA LOWENBERG-LIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 REDWOOD HWY FRONTAGE RD STE 1210
MILL VALLEY CA
94941-2483
US

IV. Provider business mailing address

1 EMBARCADERO CTR STE 1900
SAN FRANCISCO CA
94111-3723
US

V. Phone/Fax

Practice location:
  • Phone: 888-663-6331
  • Fax:
Mailing address:
  • Phone: 888-663-6331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21843
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: