Provider Demographics
NPI:1659977700
Name:LI, JOANNA
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 WESTWOOD PLAZA BOX 951752, 3108 RRUMC
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1752
Mailing Address - Country:US
Mailing Address - Phone:310-267-9132
Mailing Address - Fax:
Practice Address - Street 1:757 WESTWOOD PLZ BOX 951752, 3108 RRUMC
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-5838
Practice Address - Country:US
Practice Address - Phone:310-267-9132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician