MEDICARE: CHRISTY J 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	363LF0000X	Family Nurse Practitioner	NP95032464	CA
2	163WE0003X	Emergency Registered Nurse	RN95242065	CA

General Provider Information

NPI Number	:	1861213282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTY J LI NP

Provider Business Mailing Address
First Line	:	3503 SAN LEANDRO ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94601-3443
Country	:	US
Telephone Number	:	510-432-5084
Fax Number	:

Provider Business Practice Location Address
First Line	:	3503 SAN LEANDRO ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94601-3443
Country	:	US
Telephone Number	:	510-432-5084
Fax Number	:

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

Provider Enumeration Date	:	10/18/2024
Last Update Date	:	10/18/2024

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