Healthcare Provider Details

I. General information

NPI: 1295656197
Provider Name (Legal Business Name): LIVAN PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W 15TH ST
LIBERAL KS
67901-2455
US

IV. Provider business mailing address

300 N MAIN ST APT 211
WICHITA KS
67202-1628
US

V. Phone/Fax

Practice location:
  • Phone: 620-624-1651
  • Fax:
Mailing address:
  • Phone: 559-936-8834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: