Healthcare Provider Details

I. General information

NPI: 1689626137
Provider Name (Legal Business Name): MING-PAY LIU PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MING PAY LIU

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3102 E. HIGHLAND AVENUE MEDICAL STAFF OFFICE
PATTON CA
92369
US

IV. Provider business mailing address

3102 E. HIGHLAND AVENUE MEDICAL STAFF OFFICE
PATTON CA
92369
US

V. Phone/Fax

Practice location:
  • Phone: 909-425-7679
  • Fax: 909-425-6635
Mailing address:
  • Phone: 909-425-7679
  • Fax: 909-425-6635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number12684
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: