Healthcare Provider Details

I. General information

NPI: 1871930842
Provider Name (Legal Business Name): MRS. VICTORIA LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 PIERRE RD
WALNUT CA
91789-2531
US

IV. Provider business mailing address

142 PIERRE RD
WALNUT CA
91789-2531
US

V. Phone/Fax

Practice location:
  • Phone: 626-475-9895
  • Fax:
Mailing address:
  • Phone: 626-475-9895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number15373
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: