Healthcare Provider Details

I. General information

NPI: 1346456266
Provider Name (Legal Business Name): ZHENNI LIU M ED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNY LIU MFT

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 02/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23311 MARIBEL AVE
CARSON CA
90745-5515
US

IV. Provider business mailing address

23311 MARIBEL AVE
CARSON CA
90745-5515
US

V. Phone/Fax

Practice location:
  • Phone: 310-514-7845
  • Fax:
Mailing address:
  • Phone: 310-514-7845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number48889
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: