Healthcare Provider Details

I. General information

NPI: 1265887202
Provider Name (Legal Business Name): MICHAEL LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 W PUEBLO ST STE 102
SANTA BARBARA CA
93105-6211
US

IV. Provider business mailing address

2285 CORPORATE CIR STE 200
HENDERSON NV
89074-7759
US

V. Phone/Fax

Practice location:
  • Phone: 805-682-6455
  • Fax: 805-687-1480
Mailing address:
  • Phone: 702-360-2763
  • Fax: 949-783-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA151078
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: