Healthcare Provider Details

I. General information

NPI: 1245016526
Provider Name (Legal Business Name): VINCENT CAM LIEU NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2023
Last Update Date: 09/04/2023
Certification Date: 09/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 N MARENGO AVE APT A
ALHAMBRA CA
91801-6712
US

IV. Provider business mailing address

300 W VALLEY BLVD # 2450
ALHAMBRA CA
91803-3338
US

V. Phone/Fax

Practice location:
  • Phone: 626-922-2703
  • Fax:
Mailing address:
  • Phone: 626-922-2703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95026848
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: