Healthcare Provider Details

I. General information

NPI: 1861213282
Provider Name (Legal Business Name): CHRISTY J LI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3503 SAN LEANDRO ST
OAKLAND CA
94601-3443
US

IV. Provider business mailing address

3503 SAN LEANDRO ST
OAKLAND CA
94601-3443
US

V. Phone/Fax

Practice location:
  • Phone: 510-432-5084
  • Fax:
Mailing address:
  • Phone: 510-432-5084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95032464
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN95242065
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: