Healthcare Provider Details

I. General information

NPI: 1457236226
Provider Name (Legal Business Name): JUDITH LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2025
Last Update Date: 08/09/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2819 ALTIVO PL
FULLERTON CA
92835-1801
US

IV. Provider business mailing address

700 E BIRCH ST
BREA CA
92822-2000
US

V. Phone/Fax

Practice location:
  • Phone: 818-433-1953
  • Fax:
Mailing address:
  • Phone: 818-433-1953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95033750
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: