Healthcare Provider Details

I. General information

NPI: 1285495325
Provider Name (Legal Business Name): MARIA LIZA YUTUC LIWANAG LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 S EASTERN AVE
LAS VEGAS NV
89119-0810
US

IV. Provider business mailing address

1245 RARITAN PL
HENDERSON NV
89002-3457
US

V. Phone/Fax

Practice location:
  • Phone: 702-463-0300
  • Fax: 702-463-0301
Mailing address:
  • Phone: 714-213-0779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number841657
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: