Healthcare Provider Details

I. General information

NPI: 1265852180
Provider Name (Legal Business Name): LILY ADELZADEH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5575 W LAS POSITAS BLVD STE 230
PLEASANTON CA
94588-5802
US

IV. Provider business mailing address

2351 CLAY ST SUITE 380
SAN FRANCISCO CA
94115-1931
US

V. Phone/Fax

Practice location:
  • Phone: 925-416-1122
  • Fax:
Mailing address:
  • Phone: 415-600-3954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA159038
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: