Healthcare Provider Details

I. General information

NPI: 1942266580
Provider Name (Legal Business Name): MARIA THERESA LIQUETE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2006
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 CURTIS ELLIS DR
ROCKY MOUNT NC
27804-2237
US

IV. Provider business mailing address

220 STANDIFORD AVE STE F
MODESTO CA
95350-1159
US

V. Phone/Fax

Practice location:
  • Phone: 252-962-8000
  • Fax:
Mailing address:
  • Phone: 812-604-5870
  • Fax: 209-579-5637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2016-00646
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number39490
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC131074
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101244357
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: