Healthcare Provider Details

I. General information

NPI: 1912338450
Provider Name (Legal Business Name): LIESL FLORA PICCOLO RN LM CPM PHN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LIESL WEIMER LM CPM

II. Dates (important events)

Enumeration Date: 12/10/2013
Last Update Date: 01/01/2025
Certification Date: 01/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 HOWE ST
OAKLAND CA
94611-5312
US

IV. Provider business mailing address

3801 HOWE ST
OAKLAND CA
94611-5312
US

V. Phone/Fax

Practice location:
  • Phone: 510-752-1000
  • Fax:
Mailing address:
  • Phone: 510-752-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95022010
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN95229608
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLM 345
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: