Healthcare Provider Details

I. General information

NPI: 1750674115
Provider Name (Legal Business Name): JENNIFER CA-FEN LIU D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 07/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E ALMOND AVE
MADERA CA
93637-5606
US

IV. Provider business mailing address

1250 E ALMOND AVE
MADERA CA
93637-5606
US

V. Phone/Fax

Practice location:
  • Phone: 559-675-5512
  • Fax:
Mailing address:
  • Phone: 559-675-5512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101019092
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: