Healthcare Provider Details

I. General information

NPI: 1609930007
Provider Name (Legal Business Name): NATHANIEL S LIU DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28350 VIA SANTA ROSA
TEMECULA CA
92590-5335
US

IV. Provider business mailing address

28350 VIA SANTA ROSA
TEMECULA CA
92590-5335
US

V. Phone/Fax

Practice location:
  • Phone: 619-259-4001
  • Fax:
Mailing address:
  • Phone: 619-259-4001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number44924
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: