Healthcare Provider Details

I. General information

NPI: 1831652544
Provider Name (Legal Business Name): LIV & EVE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 COFFEE RD STE 800
MODESTO CA
95355-4240
US

IV. Provider business mailing address

PO BOX 577343
MODESTO CA
95357-7343
US

V. Phone/Fax

Practice location:
  • Phone: 209-642-1506
  • Fax:
Mailing address:
  • Phone: 209-642-2061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: AMIRA PURTO
Title or Position: OWNER
Credential:
Phone: 209-642-2061