Healthcare Provider Details

I. General information

NPI: 1891379996
Provider Name (Legal Business Name): NATALIE MICHELLE LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 05/06/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 STOCKTON BLVD NORTH ADDITION 5TH FLOOR
SACRAMENTO CA
95817
US

IV. Provider business mailing address

2335 STOCKTON BLVD NORTH ADDITION 5TH FLOOR
SACRAMENTO CA
95817
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2724
  • Fax:
Mailing address:
  • Phone: 916-734-2724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: