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General NPI Number Information
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NPI Number | 1245016526
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Entity Type | Individual
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Provider Name | VINCENT CAM LIEU NP
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Gender | Male
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Dates
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Enumeration Date | 09/04/2023
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Last Update Date | 09/04/2023
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Provider Practice Location Address
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Address Line | 116 N MARENGO AVE APT A
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City | ALHAMBRA
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State | CA
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Zip | 91801-6712
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Country | US
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Telephone | 626-922-2703
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Fax |
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Provider Business Mailing Address
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Address Line | 300 W VALLEY BLVD # 2450
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City | ALHAMBRA
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State | CA
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Zip | 91803-3338
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Country | US
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Telephone | 626-922-2703
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95026848
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License Number State | CA
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