Healthcare Provider Details

I. General information

NPI: 1518756725
Provider Name (Legal Business Name): PATRICK LIANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 RITTER ST
SAN RAFAEL CA
94901-3323
US

IV. Provider business mailing address

PO BOX 3517
SAN RAFAEL CA
94912-3517
US

V. Phone/Fax

Practice location:
  • Phone: 415-457-8182
  • Fax: 415-457-7471
Mailing address:
  • Phone: 415-457-8182
  • Fax: 415-457-7471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95037719
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number281471
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: