MEDICARE: CARMEN LI NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	95022301	CA

General Provider Information

NPI Number	:	1811671910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEN LI NP

Provider Business Mailing Address
First Line	:	5536 SULTANA AVE
Second Line	:
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780-2322
Country	:	US
Telephone Number	:	626-217-5863
Fax Number	:

Provider Business Practice Location Address
First Line	:	2530 SAN VICENTE BLVD
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90402-2321
Country	:	US
Telephone Number	:	310-310-3776
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2023
Last Update Date	:	06/09/2023

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