Healthcare Provider Details

I. General information

NPI: 1023860277
Provider Name (Legal Business Name): MIA LIU IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7515 IRVINE CENTER DR STE 110
IRVINE CA
92618-2913
US

IV. Provider business mailing address

7515 IRVINE CENTER DR STE 110
IRVINE CA
92618-2913
US

V. Phone/Fax

Practice location:
  • Phone: 949-889-6999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-319874
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: