Provider Demographics
NPI:1588130470
Name:DEOMPOC, LEXI (NP)
Entity type:Individual
Prefix:
First Name:LEXI
Middle Name:
Last Name:DEOMPOC
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 CAMPUS DR APT 213
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-4912
Mailing Address - Country:US
Mailing Address - Phone:847-208-7144
Mailing Address - Fax:
Practice Address - Street 1:500 PARNASSUS AVE # MUW405
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2203
Practice Address - Country:US
Practice Address - Phone:415-353-1606
Practice Address - Fax:415-353-4716
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2020-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009885363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily