Healthcare Provider Details

I. General information

NPI: 1023233061
Provider Name (Legal Business Name): MENG LIU L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 E HIGHLAND AVE STE 502
SAN BERNARDINO CA
92404-3872
US

IV. Provider business mailing address

1606 KIOWA CREST DR
DIAMOND BAR CA
91765-2909
US

V. Phone/Fax

Practice location:
  • Phone: 909-228-7359
  • Fax:
Mailing address:
  • Phone: 909-860-1858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number4872
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: