MEDICARE: DR. LIANE RACHEL BACAL M.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	207Q00000X	Family Medicine Physician	AFE103264	CA

General Provider Information

NPI Number	:	1518231331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LIANE RACHEL BACAL M.D.

Provider Business Mailing Address
First Line	:	4962 EL CAMINO REAL
Second Line	:	SUITE 103
City	:	LOS ALTOS
State	:	CA
Zip	:	94022-1454
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4962 EL CAMINO REAL
Second Line	:	SUITE 103
City	:	LOS ALTOS
State	:	CA
Zip	:	94022-1454
Country	:	US
Telephone Number	:	650-319-8577
Fax Number	:

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

Provider Enumeration Date	:	02/24/2012
Last Update Date	:	01/12/2016

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