Healthcare Provider Details

I. General information

NPI: 1164070710
Provider Name (Legal Business Name): ELIZABETH KAREN LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1985 ZONAL AVE # 206A
LOS ANGELES CA
90089-5305
US

IV. Provider business mailing address

304 CALLE ALCAZAR
WALNUT CA
91789-1614
US

V. Phone/Fax

Practice location:
  • Phone: 626-802-0310
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number44790
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: