Healthcare Provider Details

I. General information

NPI: 1952758179
Provider Name (Legal Business Name): DALU LIU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6530 RHONE CT
HIGHLAND CA
92346-2669
US

IV. Provider business mailing address

6530 RHONE CT
HIGHLAND CA
92346-2669
US

V. Phone/Fax

Practice location:
  • Phone: 909-864-1638
  • Fax:
Mailing address:
  • Phone: 909-864-1638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC16485
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: