Provider Demographics
NPI:1285121582
Name:LIU, QIANNA
Entity type:Individual
Prefix:
First Name:QIANNA
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 1/2 VERDUGO RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-3820
Mailing Address - Country:US
Mailing Address - Phone:323-297-0884
Mailing Address - Fax:
Practice Address - Street 1:11888 BARTLETT AVE
Practice Address - Street 2:
Practice Address - City:ADELANTO
Practice Address - State:CA
Practice Address - Zip Code:92301-1709
Practice Address - Country:US
Practice Address - Phone:760-530-9944
Practice Address - Fax:760-530-9977
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA20A18703207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program