Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | A64597 | CA |
Y | 207ND0101X | MOHS-Micrographic Surgeon | A64597 | CA |
NPI | 1235161308 |
---|---|
Provider Name | Alice Y Liu |
First Address | Oceanside, CA 92056-4522 |
Second Address | Oceanside, CA 92056-4522 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 04/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H28232 | (02) | |
H28232 | (02) | CA |