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General NPI Number Information
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NPI Number | 1356606263
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Entity Type | Individual
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Provider Name | MARY LI MA MD
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Gender | Female
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Dates
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Enumeration Date | 07/06/2012
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 5555 GROSSMONT CENTER DR
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City | LA MESA
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State | CA
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Zip | 91942-3019
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Country | US
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Telephone | 619-740-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 823 GATEWAY CENTER WAY
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City | SAN DIEGO
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State | CA
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Zip | 92102-4541
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Country | US
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Telephone | 619-515-2300
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 284755
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | C187124
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License Number State | CA
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