Individual
TINA GRACE LI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
9985 SIERRA AVE, FONTANA, CA 92335-6720
(310) 497-0308
Mailing address
9985 SIERRA AVE, FONTANA, CA 92335-6720
(310) 497-0308
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
A71525
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A715250
MEDICAL PPIN #
CA
Enumeration date
07/24/2006
Last updated
07/08/2007
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