Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 41634 | AZ |
N | 2080A0000X | Adolescent Medicine | 233363 | NY |
N | 2080A0000X | Adolescent Medicine | 41634 | AZ |
NPI | 1063636512 |
---|---|
Provider Name | Dr. Tina Yuling Liao |
First Address | Casa Grande, AZ 85130-0020 |
Second Address | Casa Grande, AZ 85122-5303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 02/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
420824 | (05) | AZ |