Provider Demographics
NPI:1578926317
Name:LI, QIUYUE
Entity Type:Individual
Prefix:
First Name:QIUYUE
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:QIUYUE
Other - Middle Name:
Other - Last Name:LI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:399 E HIGHLAND AVE STE 502
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-3872
Mailing Address - Country:US
Mailing Address - Phone:909-883-3838
Mailing Address - Fax:909-883-2328
Practice Address - Street 1:399 E HIGHLAND AVE STE 502
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3872
Practice Address - Country:US
Practice Address - Phone:909-883-3838
Practice Address - Fax:909-883-2328
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003226363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily