Healthcare Provider Details

I. General information

NPI: 1508968918
Provider Name (Legal Business Name): CYNTHIA LIU CNM, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 INTERNATIONAL CIRCLE
SAN JOSE CA
95119
US

IV. Provider business mailing address

276 INTERNATIONAL CIRCLE
SAN JOSE CA
95119
US

V. Phone/Fax

Practice location:
  • Phone: 408-362-4740
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number466692
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: