Healthcare Provider Details

I. General information

NPI: 1508147034
Provider Name (Legal Business Name): SILVIA LIU PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2011
Last Update Date: 02/16/2024
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 WILSHIRE BLVD STE 615
LOS ANGELES CA
90025-1022
US

IV. Provider business mailing address

711 7TH ST
SANTA MONICA CA
90402-2711
US

V. Phone/Fax

Practice location:
  • Phone: 310-312-1015
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY94026324
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY94026324
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: