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General NPI Number Information
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NPI Number | 1427952563
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Entity Type | Organization
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Legal Business Name | BLUE LOTUS HEALTH LLC
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Dates
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Enumeration Date | 10/05/2026
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Last Update Date | 10/05/2026
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Provider Practice Location Address
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Address Line | 922 S TUPPER CT
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City | MOUNTAIN HOUSE
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State | CA
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Zip | 95391-1426
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Country | US
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Telephone | 510-736-9104
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Fax |
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Provider Business Mailing Address
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Address Line | 922 S TUPPER CT
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City | MOUNTAIN HOUSE
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State | CA
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Zip | 95391-1426
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Country | US
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Telephone | 510-736-9104
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MISS NESREN ANTON
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Credential | NP
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Telephone | 510-736-9104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State | NULL
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