Healthcare Provider Details

I. General information

NPI: 1730282658
Provider Name (Legal Business Name): LI FAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 08/20/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15525 POMERADO RD STE C1
POWAY CA
92064-2425
US

IV. Provider business mailing address

15525 POMERADO RD STE C1
POWAY CA
92064-2425
US

V. Phone/Fax

Practice location:
  • Phone: 858-451-7944
  • Fax: 858-451-0082
Mailing address:
  • Phone: 858-451-7944
  • Fax: 858-451-0082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC132851
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberC132851
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: