Healthcare Provider Details

I. General information

NPI: 1548417926
Provider Name (Legal Business Name): LIANA MAXA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 BATTERSBY AVE
ENUMCLAW WA
98022-3634
US

IV. Provider business mailing address

1455 BATTERSBY AVE
ENUMCLAW WA
98022-3634
US

V. Phone/Fax

Practice location:
  • Phone: 253-426-6341
  • Fax: 360-697-2514
Mailing address:
  • Phone: 253-426-6341
  • Fax: 360-697-2514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberMD60251154
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60251154
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD60251154
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: