Basic Information
| Provider Information | |||||||||
| NPI: | 1902269087 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BIRD | ||||||||
| FirstName: | LIAT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 16TH ST FL 4 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941582545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154437595 | ||||||||
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| Practice Location | |||||||||
| Address1: | 550 16TH ST | ||||||||
| Address2: | 4TH FLOOR, 4551, BOX 0110, | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154766245 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2016 | ||||||||
| LastUpdateDate: | 06/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208000000X | A153651 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.