MEDICARE: RINA LI

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	363A00000X	Physician Assistant	10015	AZ

General Provider Information

NPI Number	:	1972264877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RINA LI

Provider Business Mailing Address
First Line	:	PO BOX 10097
Second Line	:
City	:	CASA GRANDE
State	:	AZ
Zip	:	85130-0020
Country	:	US
Telephone Number	:	520-836-3446
Fax Number	:

Provider Business Practice Location Address
First Line	:	1284 N ARIZONA BLVD
Second Line	:
City	:	COOLIDGE
State	:	AZ
Zip	:	85128-3206
Country	:	US
Telephone Number	:	520-723-9131
Fax Number	:

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

Provider Enumeration Date	:	01/04/2022
Last Update Date	:	11/02/2023

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Directions to “ RINA LI ” Practice Location

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