Healthcare Provider Details

I. General information

NPI: 1811176175
Provider Name (Legal Business Name): TRACY ESTHER LIU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 01/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2485 HOSPITAL DR SUITE 260
MOUNTAIN VIEW CA
94040-4103
US

IV. Provider business mailing address

2485 HOSPITAL DR. SUITE 260
MOUNTAIN VIEW CA
94040-4103
US

V. Phone/Fax

Practice location:
  • Phone: 650-988-7588
  • Fax: 650-988-7592
Mailing address:
  • Phone: 650-988-7588
  • Fax: 650-988-7592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA36764
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: