Healthcare Provider Details

I. General information

NPI: 1780047779
Provider Name (Legal Business Name): LULU REBECCA TSAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA LU TSAO

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PARNASSUS AVE FL 2
SAN FRANCISCO CA
94143-2202
US

IV. Provider business mailing address

400 PARNASSUS AVE BOX 0336
SAN FRANCISCO CA
94143-2204
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2725
  • Fax: 415-353-3529
Mailing address:
  • Phone: 415-353-2725
  • Fax: 415-353-3529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberA152982
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: