Individual
LIESL CLOSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1411 E 31ST ST, OAKLAND, CA 94602-1092
(415) 353-7500
Mailing address
505 PARNASSUS AVE RM M779, SAN FRANCISCO, CA 94143-2204
(415) 353-7500
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
A174945
CA
208600000X
Surgery Physician
R73227
AZ
282N00000X
General Acute Care Hospital
R-9872
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A174945
MEDICAL LICENSE
CA
Enumeration date
06/25/2012
Last updated
10/14/2021
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