Provider Demographics
NPI:1801089578
Name:LOWE, LIBERTY GRACE (MD)
Entity type:Individual
Prefix:DR
First Name:LIBERTY
Middle Name:GRACE
Last Name:LOWE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28311 CAMINO LA RONDA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-5808
Mailing Address - Country:US
Mailing Address - Phone:310-614-3349
Mailing Address - Fax:
Practice Address - Street 1:801 W CIVIC CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4079
Practice Address - Country:US
Practice Address - Phone:714-796-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93401208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics