MEDICARE: DR. ERIN LEIGH DORNAN-LIUZZO PSY.D.

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
1	103TC0700X	Clinical Psychologist	23256	CA

General Provider Information

NPI Number	:	1386772663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIN LEIGH DORNAN-LIUZZO PSY.D.

Provider Business Mailing Address
First Line	:	18627 BROOKHURST ST # 194
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-6748
Country	:	US
Telephone Number	:	949-345-1186
Fax Number	:

Provider Business Practice Location Address
First Line	:	3151 AIRWAY AVE STE A2
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-4620
Country	:	US
Telephone Number	:	949-345-1186
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	11/21/2018

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