Provider Demographics
NPI:1184157620
Name:LIU, JESICA FERNANDA (MD)
Entity type:Individual
Prefix:
First Name:JESICA
Middle Name:FERNANDA
Last Name:LIU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESICA
Other - Middle Name:FERNANDA
Other - Last Name:RAMIREZ VARGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9500 GILMAN DR # MC0832
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-0927
Mailing Address - Country:US
Mailing Address - Phone:858-246-0794
Mailing Address - Fax:858-246-0019
Practice Address - Street 1:7910 FROST ST STE 230
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2776
Practice Address - Country:US
Practice Address - Phone:858-246-0053
Practice Address - Fax:858-496-9257
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA1663122080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program