Healthcare Provider Details

I. General information

NPI: 1083504468
Provider Name (Legal Business Name): ROSA LEE RN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 UNION ST
SAN FRANCISCO CA
94123-4426
US

IV. Provider business mailing address

1889 HARRISON ST UNIT 436
OAKLAND CA
94612-3509
US

V. Phone/Fax

Practice location:
  • Phone: 650-810-5561
  • Fax:
Mailing address:
  • Phone: 650-810-5561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95036063
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number9532123
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: