Provider Demographics
NPI:1295856524
Name:GARCIA LIU, LYDIA (MS)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:GARCIA LIU
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 E WAVERLY ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-3850
Mailing Address - Country:US
Mailing Address - Phone:520-326-8301
Mailing Address - Fax:
Practice Address - Street 1:1400 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-5825
Practice Address - Country:US
Practice Address - Phone:520-225-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1394235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1394OtherAZ LICENSE NUMBER
AZ639990Medicaid