Healthcare Provider Details

I. General information

NPI: 1548359169
Provider Name (Legal Business Name): LILLIAN SHUMATE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LILLIAN LIM LIAO M.D.

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 FLORIDA AVE STE 207
MODESTO CA
95350-4445
US

IV. Provider business mailing address

2625F COFFEE RD STE 215
MODESTO CA
95355-2007
US

V. Phone/Fax

Practice location:
  • Phone: 209-525-3845
  • Fax: 209-525-3852
Mailing address:
  • Phone: 209-522-2463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberA25546
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: