Provider Demographics
NPI:1417129156
Name:LIAO, ELLEN (PA-C)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:LIAO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 6TH AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-3010
Mailing Address - Country:US
Mailing Address - Phone:415-833-2291
Mailing Address - Fax:415-833-2291
Practice Address - Street 1:450 6TH AVE FL 5
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-3010
Practice Address - Country:US
Practice Address - Phone:415-833-2291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19453363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant