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General NPI Number Information
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NPI Number | 1942617717
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Entity Type | Individual
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Provider Name | CAROL LI
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Gender | Female
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Dates
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Enumeration Date | 07/14/2014
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 416 PAYRAN ST
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City | PETALUMA
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State | CA
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Zip | 94952-5907
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Country | US
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Telephone | 707-778-6242
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Fax |
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Provider Business Mailing Address
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Address Line | 416 PAYRAN ST
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City | PETALUMA
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State | CA
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Zip | 94952-5907
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Country | US
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Telephone | 707-778-6242
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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 | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | OS13851
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | 20A22657
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License Number State | CA
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