Healthcare Provider Details

I. General information

NPI: 1154843068
Provider Name (Legal Business Name): HAILI QIU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W HUNTINGTON DR
ARCADIA CA
91007-3402
US

IV. Provider business mailing address

1512 ACACIA APT A
ALHAMBRA CA
91801-3186
US

V. Phone/Fax

Practice location:
  • Phone: 626-898-8000
  • Fax: 626-574-3592
Mailing address:
  • Phone: 626-679-2380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95291299
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number431346
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number716553-1
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95022202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: