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NPI Code Detail

MEDICARE: BRANDY LIU D.O.

MEDICARE: BRANDY LIU D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12083A0300XAddiction Medicine (Preventive Medicine) Physician20A14179CA
22083B0002XObesity Medicine (Preventive Medicine) Physician20A14179CA
32083P0901XPublic Health & General Preventive Medicine Physician20A14179CA
4207RA0401XAddiction Medicine (Internal Medicine) Physician20A14179CA

General Provider Information

NPI Number : 1093150559
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDY LIU D.O.
Provider Business Mailing Address
First Line : 5120 HAMNER AVE
Second Line : STE 140 #568
City : MIRA LOMA
State : CA
Zip : 91752-3802
Country : US
Telephone Number : 951-298-9987
Fax Number :
Provider Business Practice Location Address
First Line : 4193 FLAT ROCK DR STE 200
Second Line :
City : RIVERSIDE
State : CA
Zip : 92505-7113
Country : US
Telephone Number : 626-208-9377
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2013
Last Update Date : 04/21/2023

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