Healthcare Provider Details

I. General information

NPI: 1891344347
Provider Name (Legal Business Name): PACIFIC PSYCHIATRIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2019
Last Update Date: 09/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 9TH ST STE 401
OAKLAND CA
94607-4428
US

IV. Provider business mailing address

1410 LAKESHORE AVE APT 6
OAKLAND CA
94606-1660
US

V. Phone/Fax

Practice location:
  • Phone: 510-285-6359
  • Fax: 510-879-7406
Mailing address:
  • Phone: 415-686-9128
  • Fax: 510-879-7406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMANTHA LANDIE LIU
Title or Position: PRESIDENT
Credential: MD
Phone: 415-686-9128