Basic Information
| Provider Information | |||||||||
| NPI: | 1386904274 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VALDIVIA | ||||||||
| FirstName: | LIZA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 PARNASSUS AVE, BOX 0336, 2ND FLOOR | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4153532626 | ||||||||
| FaxNumber: | 4153533538 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 PARNASSUS AVE, 2ND FLOOR | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4153532626 | ||||||||
| FaxNumber: | 4153533538 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2012 | ||||||||
| LastUpdateDate: | 10/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A166589 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | A166589 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.