Provider Demographics
NPI:1245016526
Name:LIEU, VINCENT CAM (NP)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:CAM
Last Name:LIEU
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W VALLEY BLVD # 2450
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-3338
Mailing Address - Country:US
Mailing Address - Phone:626-922-2703
Mailing Address - Fax:
Practice Address - Street 1:116 N MARENGO AVE APT A
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-6712
Practice Address - Country:US
Practice Address - Phone:626-922-2703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95026848363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health