Provider Demographics
NPI:1508742032
Name:LI, ISABEL SONG (RN)
Entity type:Individual
Prefix:
First Name:ISABEL
Middle Name:SONG
Last Name:LI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4459 VIEW PL
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-4213
Mailing Address - Country:US
Mailing Address - Phone:732-770-9116
Mailing Address - Fax:
Practice Address - Street 1:1100 SAN LEANDRO BLVD FL 4
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-1595
Practice Address - Country:US
Practice Address - Phone:510-208-5930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95291922163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse