Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A136064 | CA |
Y | 2080P0204X | Pediatric Emergency Doctor | A136064 | CA |
NPI | 1073879300 |
---|---|
Provider Name | Natasha Li |
First Address | Loma Linda, CA 92354-2804 |
Second Address | Loma Linda, CA 92354-2804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2012 |
Last Update Date | 02/04/2018 |