Healthcare Provider Details

I. General information

NPI: 1982155263
Provider Name (Legal Business Name): LIVANTA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 CATAWBA VALLEY BLVD SE
HICKORY NC
28602
US

IV. Provider business mailing address

2105 CATAWBA VALLEY BLVD SE
HICKORY NC
28602-4151
US

V. Phone/Fax

Practice location:
  • Phone: 828-358-0000
  • Fax: 828-544-8284
Mailing address:
  • Phone: 828-358-0000
  • Fax: 828-544-8284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DALAN D GARCIA
Title or Position: OWNER
Credential: PA
Phone: 909-631-7501