Healthcare Provider Details

I. General information

NPI: 1902604218
Provider Name (Legal Business Name): LYDIA ADA VANOSTER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 03/04/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 2ND ST SUITE 102
SAN FRANCISCO CA
94107
US

IV. Provider business mailing address

105 N 1ST ST #486
SAN JOSE CA
95103
US

V. Phone/Fax

Practice location:
  • Phone: 844-472-5634
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number95395482
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: