Individual
LILLY PAKAWONGSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, MSN, CPNP-PC
Contact information
Practice address
2970 HILLTOP MALL RD STE 305, RICHMOND, CA 94806-5274
(510) 222-5437
(510) 222-5487
Mailing address
2425 GEARY BLVD, SAN FRANCISCO, CA 94115-3358
(510) 541-1101
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
95066338
CA
363LP0200X
Pediatric Nurse Practitioner
Primary
95007505
CA
Other
Enumeration date
10/09/2017
Last updated
01/11/2022
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