Healthcare Provider Details

I. General information

NPI: 1659981884
Provider Name (Legal Business Name): LIV ADVANTIA DC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1443 U ST NW
WASHINGTON DC
20009-3974
US

IV. Provider business mailing address

1443 U ST NW
WASHINGTON DC
20009-3974
US

V. Phone/Fax

Practice location:
  • Phone: 202-315-5223
  • Fax:
Mailing address:
  • Phone: 202-481-9205
  • Fax: 833-629-0566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA DODSON
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 443-398-0189