Healthcare Provider Details

I. General information

NPI: 1588866578
Provider Name (Legal Business Name): WALTER LI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2007
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVENUE, RM 1235 PEDIATRIC DIVISION OF CARDIOLOGY, UCSF
SAN FRANCISCO CA
94143
US

IV. Provider business mailing address

505 PARNASSUS AVENUE, RM 1235 PEDIATRIC DIVISION OF CARDIOLOGY, UCSF
SAN FRANCISCO CA
94143
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-4141
  • Fax: 415-353-4144
Mailing address:
  • Phone: 415-353-4141
  • Fax: 415-353-4144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA99014
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberA99014
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: