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General NPI Number Information
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NPI Number | 1295915437
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Entity Type | Individual
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Provider Name | WANDA WAN LIAN ZHAO PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/05/2007
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Last Update Date | 12/09/2013
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Provider Practice Location Address
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Address Line | 1100 S. ELISEO AVE STE 2A SIRONA VASCULAR CENTER
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City | GREENBRAE
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State | CA
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Zip | 94904-2017
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Country | US
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Telephone | 415-464-5400
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Fax | 415-464-5413
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Provider Business Mailing Address
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Address Line | GROUP ADDRESS OF PO BOX 45094
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City | SAN FRANCISCO
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State | CA
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Zip | 94145-0094
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 001982
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 19704
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License Number State | CA
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