Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MT190997 | PA |
N | 111NI0900X | Internist | MT190997 | PA |
Y | 207RR0500X | Rheumatology | A130460 | CA |
N | 207RR0500X | Rheumatology | MD438937 | PA |
NPI | 1093965758 |
---|---|
Provider Name | Dr. Sophia S Li |
First Address | Rancho Cucamonga, CA 91737-2161 |
Second Address | Loma Linda, CA 92357-3450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2008 |
Last Update Date | 04/06/2020 |