Healthcare Provider Details

I. General information

NPI: 1134451438
Provider Name (Legal Business Name): LISA TOSHIYE TANIWA RYUJIN M.D./M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2010
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 W MACARTHUR BLVD
OAKLAND CA
94611-5642
US

IV. Provider business mailing address

1550 GATEWAY BLVD
FAIRFIELD CA
94533-6901
US

V. Phone/Fax

Practice location:
  • Phone: 510-752-7772
  • Fax:
Mailing address:
  • Phone: 707-427-4478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA 110675
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: