Livewell Medical Clinic Inc

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

G78328 Issued in CA

Legal business name

LIVEWELL MEDICAL CLINIC INC

Practice address

1150 El Camino Real
#225
San Bruno, CA 94066

Phone

(650) 873-3338

Fax

(650) 873-3308

NPI assigned

Sep 28, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Maria Luisa Osmona, MD

Title

President Owner

Phone

(650) 873-3338

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Maria Luisa Osmena, MD

  • Pediatrics Physician
  • San Bruno, CA
  • NPI 1922172162
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1770675886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5528 PACHECO BLVD",
            "address_2": "STE A",
            "city": "PACHECO",
            "state": "CA",
            "postal_code": "94553",
            "telephone_number": "925-363-8170",
            "fax_number": "925-363-4995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 EL CAMINO REAL",
            "address_2": "#225",
            "city": "SAN BRUNO",
            "state": "CA",
            "postal_code": "94066",
            "telephone_number": "650-873-3338",
            "fax_number": "650-873-3308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVEWELL MEDICAL CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "OSMONA",
        "authorized_official_first_name": "MARIA",
        "authorized_official_middle_name": "LUISA",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "650-873-3338",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G78328",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A78723",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0101840",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jonathan Melton Lish, MD
• Nancy J Littlefield
• Nico Liu-Lo Buglio
• Chunan Liu
• Zhibin Liu
• Jared Locklear-Sykes
• Rex Lockwood, D.C.
• Prince Nonito Locop
• Jashwi Lodhia
• Samantha Logan

• Pediatrics Physician in San Bruno, CA
• Providers in San Bruno, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.