Healthcare Provider Details

I. General information

NPI: 1174781595
Provider Name (Legal Business Name): LIANA STEFAN LIANOV MD MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 J ST
SACRAMENTO CA
95814
US

IV. Provider business mailing address

PO BOX 4038 SUITE 200
SACRAMENTO CA
95812
US

V. Phone/Fax

Practice location:
  • Phone: 916-765-5116
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG066694
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number51038
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: