Healthcare Provider Details

I. General information

NPI: 1467554287
Provider Name (Legal Business Name): WINSON LIU, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 SHERMAN DR SUITE 10
RIVERSIDE CA
92503-4001
US

IV. Provider business mailing address

3838 SHERMAN DR SUITE 10
RIVERSIDE CA
92503-4001
US

V. Phone/Fax

Practice location:
  • Phone: 951-688-3849
  • Fax: 951-688-8045
Mailing address:
  • Phone: 951-688-3849
  • Fax: 951-688-8045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA64329
License Number StateCA

VIII. Authorized Official

Name: DR. WINSON LIU
Title or Position: PRESIDENT
Credential: M.D.
Phone: 951-688-3849