1326281064 NPI number — JUSTIN LIU MD PROFESSIONAL MEDICAL CORPORATION

Table of content: IVANA FABIOLA MARTINEZ ARENAS (NPI 1356215446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326281064 NPI number — JUSTIN LIU MD PROFESSIONAL MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JUSTIN LIU MD PROFESSIONAL MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326281064
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1839 YGNACIO VALLEY RD # 418
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALNUT CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94598-3214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-820-4230
Provider Business Mailing Address Fax Number:
925-820-7996

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
JOHN MUIR HOSPITAL-DEPT OF PHYSICAL MED/ REHAB
Provider Second Line Business Practice Location Address:
1601 YGNACIO VALLEY ROAD
Provider Business Practice Location Address City Name:
WALNUT CREEK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94598
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-820-4230
Provider Business Practice Location Address Fax Number:
925-820-7996
Provider Enumeration Date:
04/10/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LIU
Authorized Official First Name:
JUSTIN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
925-820-4230

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  A76636 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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