Provider Demographics
NPI:1225406358
Name:LIU, SERENA
Entity Type:Individual
Prefix:
First Name:SERENA
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 1:292 VALVERDE AVE
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5958
Mailing Address - Country:US
Mailing Address - Phone:714-718-4699
Mailing Address - Fax:
Practice Address - Street 1:88 ROWLAND WAY
Practice Address - Street 2:#250
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-5042
Practice Address - Country:US
Practice Address - Phone:415-898-1311
Practice Address - Fax:415-897-0741
Is Sole Proprietor?:No
Enumeration Date:2015-09-06
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10620225100000X
NV3276225100000X
IN05011909A225100000X
CA291884225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist