Provider Demographics
NPI:1922262724
Name:LI, JANE (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:LI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:290 MAPLE CT
Mailing Address - Street 2:SUITE 107
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3517
Mailing Address - Country:US
Mailing Address - Phone:805-256-5527
Mailing Address - Fax:805-856-0432
Practice Address - Street 1:290 MAPLE CT
Practice Address - Street 2:SUITE 107
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3517
Practice Address - Country:US
Practice Address - Phone:805-256-5527
Practice Address - Fax:805-856-0432
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1042982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry