Healthcare Provider Details

I. General information

NPI: 1295431088
Provider Name (Legal Business Name): MICHELLE LIU PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20700 LAKE CHABOT RD STE 107
CASTRO VALLEY CA
94546-5402
US

IV. Provider business mailing address

20700 LAKE CHABOT RD STE 107
CASTRO VALLEY CA
94546-5402
US

V. Phone/Fax

Practice location:
  • Phone: 510-886-5515
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA62452
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: