Provider Demographics
NPI:1003248212
Name:LIAO, TERESA L (LAC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:LIAO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20432 SILVERADO AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-4454
Mailing Address - Country:US
Mailing Address - Phone:408-252-7200
Mailing Address - Fax:408-996-0800
Practice Address - Street 1:20432 SILVERADO AVE STE 1
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-4454
Practice Address - Country:US
Practice Address - Phone:408-252-7200
Practice Address - Fax:408-996-0800
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15431171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC15431OtherCALIFORNIA ACUPUNCTURE BOARD