Healthcare Provider Details

I. General information

NPI: 1588130470
Provider Name (Legal Business Name): LEXI DEOMPOC NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2018
Last Update Date: 03/28/2020
Certification Date: 03/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 PARNASSUS AVE # MUW405
SAN FRANCISCO CA
94143-2203
US

IV. Provider business mailing address

860 CAMPUS DR APT 213
DALY CITY CA
94015-4912
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-1606
  • Fax: 415-353-4716
Mailing address:
  • Phone: 847-208-7144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95009885
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: