Healthcare Provider Details

I. General information

NPI: 1902269087
Provider Name (Legal Business Name): LIAT BIRD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 16TH ST 4TH FLOOR, 4551, BOX 0110,
SAN FRANCISCO CA
94143
US

IV. Provider business mailing address

550 16TH ST FL 4
SAN FRANCISCO CA
94158-2545
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-6245
  • Fax:
Mailing address:
  • Phone: 415-443-7595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA153651
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: