Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | A70793 | CA |
NPI | 1003837386 |
---|---|
Provider Name | Marina Liu |
First Address | Los Angeles, CA 90074-5799 |
Second Address | Loma Linda, CA 92354-2804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A707930 | (05) | CA |
H61163 | (02) |