Healthcare Provider Details

I. General information

NPI: 1891301511
Provider Name (Legal Business Name): ANGELINA LIAO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGIE LIAO

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 W ALLUVIAL AVE STE 101
FRESNO CA
93711-5509
US

IV. Provider business mailing address

9 BERGAMO
IRVINE CA
92614-5324
US

V. Phone/Fax

Practice location:
  • Phone: 559-432-9800
  • Fax: 559-797-3543
Mailing address:
  • Phone: 949-878-0318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number82872
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: