Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 19121 | PR |
NPI | 1023409984 |
---|---|
Provider Name | Mrs. Luciol D Livette |
First Address | San Juan, PR 00936-4708 |
Second Address | San Juan, PR 00918 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2015 |
Last Update Date | 28/08/2017 |