Healthcare Provider Details

I. General information

NPI: 1457706020
Provider Name (Legal Business Name): RUBY LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W TOWN AND COUNTRY RD STE 1600
ORANGE CA
92868-4698
US

IV. Provider business mailing address

1333 GRAND CANAL
IRVINE CA
92620-1895
US

V. Phone/Fax

Practice location:
  • Phone: 323-728-7232
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number65439
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: