MEDICARE: YAN LI LIU FNP

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	363LF0000X	Family Nurse Practitioner	95007629	CA

General Provider Information

NPI Number	:	1942841267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAN LI LIU FNP

Provider Business Mailing Address
First Line	:	6880 GUINEVERE CT
Second Line	:
City	:	EASTVALE
State	:	CA
Zip	:	92880-3644
Country	:	US
Telephone Number	:	626-991-6459
Fax Number	:

Provider Business Practice Location Address
First Line	:	2373 S HACIENDA BLVD
Second Line	:
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-4613
Country	:	US
Telephone Number	:	626-536-1602
Fax Number	:

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

Provider Enumeration Date	:	10/08/2019
Last Update Date	:	08/10/2023

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