Provider Demographics
NPI:1508111725
Name:LIU, CAROLE SU-YEN (NP)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:SU-YEN
Last Name:LIU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 E CESAR E CHAVEZ AVE STE 125
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-2445
Mailing Address - Country:US
Mailing Address - Phone:323-224-2100
Mailing Address - Fax:323-224-2106
Practice Address - Street 1:1701 E CESAR E CHAVEZ AVE STE 125
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2445
Practice Address - Country:US
Practice Address - Phone:323-224-2100
Practice Address - Fax:323-224-2106
Is Sole Proprietor?:No
Enumeration Date:2012-07-14
Last Update Date:2012-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP21174363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care