Healthcare Provider Details

I. General information

NPI: 1548932510
Provider Name (Legal Business Name): MR. GUOQING LIU I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3237 SANTA CLARA AVE # A
EL CERRITO CA
94530-3848
US

IV. Provider business mailing address

3237 SANTA CLARA AVE # A
EL CERRITO CA
94530-3848
US

V. Phone/Fax

Practice location:
  • Phone: 510-816-1180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number78058
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: