MEDICARE: DR. ALIA ANNETTE CREASEY LILIENSTEIN M.D., M.P.H.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A136775	CA

General Provider Information

NPI Number	:	1689936007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALIA ANNETTE CREASEY LILIENSTEIN M.D., M.P.H.

Provider Business Mailing Address
First Line	:	1403 STANNAGE AVE
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94702-1031
Country	:	US
Telephone Number	:	510-708-4622
Fax Number	:

Provider Business Practice Location Address
First Line	:	1403 STANNAGE AVE
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94702-1031
Country	:	US
Telephone Number	:	510-708-4622
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2012
Last Update Date	:	11/27/2022

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