Healthcare Provider Details

I. General information

NPI: 1366952020
Provider Name (Legal Business Name): LILLY PAKAWONGSE RN, MSN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LILLY FELDMAN RN, MSN, CPNP-PC

II. Dates (important events)

Enumeration Date: 10/09/2017
Last Update Date: 01/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 HILLTOP MALL RD STE 305
RICHMOND CA
94806-5274
US

IV. Provider business mailing address

2425 GEARY BLVD
SAN FRANCISCO CA
94115-3358
US

V. Phone/Fax

Practice location:
  • Phone: 510-222-5437
  • Fax: 510-222-5487
Mailing address:
  • Phone: 510-541-1101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95066338
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95007505
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: