Healthcare Provider Details

I. General information

NPI: 1013207364
Provider Name (Legal Business Name): YI-TIEN LIU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 W VALLEY BLVD STE 100
SAN GABRIEL CA
91776-3731
US

IV. Provider business mailing address

506 W VALLEY BLVD STE 100
SAN GABRIEL CA
91776-3731
US

V. Phone/Fax

Practice location:
  • Phone: 626-308-3800
  • Fax: 626-308-1899
Mailing address:
  • Phone: 626-308-3800
  • Fax: 626-308-1899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP20598
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: