Healthcare Provider Details

I. General information

NPI: 1033028246
Provider Name (Legal Business Name): LIVISTON DAVID SAAVEDRA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 SAINT NICHOLAS AVE APT 64
NEW YORK NY
10030-1050
US

IV. Provider business mailing address

695 SAINT NICHOLAS AVE APT 64
NEW YORK NY
10030-1050
US

V. Phone/Fax

Practice location:
  • Phone: 551-404-8910
  • Fax:
Mailing address:
  • Phone: 551-404-8910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number034233
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: