Healthcare Provider Details

I. General information

NPI: 1588047849
Provider Name (Legal Business Name): OBSTETRICS & GYNECOLOGY LI FAN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15725 POMERADO RD STE 207
POWAY CA
92064-2059
US

IV. Provider business mailing address

15725 POMERADO ROAD STE 207
POWAY CA
92064
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberC132851
License Number StateCA

VIII. Authorized Official

Name: DR. LI FAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 858-451-7944