Provider Demographics
NPI:1245600774
Name:LI, DENISE T (NP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:T
Last Name:LI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1452
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-1452
Mailing Address - Country:US
Mailing Address - Phone:925-360-5835
Mailing Address - Fax:925-462-7258
Practice Address - Street 1:3694 HAPPY VALLEY RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3040
Practice Address - Country:US
Practice Address - Phone:925-360-5835
Practice Address - Fax:925-462-7258
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-27
Last Update Date:2015-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA391756163W00000X
CA95001523363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse