Healthcare Provider Details

I. General information

NPI: 1477414167
Provider Name (Legal Business Name): QIAOMIN LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2025
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13732 BOSTON CT
FONTANA CA
92336-3446
US

IV. Provider business mailing address

13732 BOSTON CT
FONTANA CA
92336-3446
US

V. Phone/Fax

Practice location:
  • Phone: 626-495-8339
  • Fax:
Mailing address:
  • Phone: 626-495-8339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number86559
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: