Healthcare Provider Details

I. General information

NPI: 1538120464
Provider Name (Legal Business Name): LIVIA C DEVARIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

C/ RUBI A 6 BO AMELIA
GUAYNABO PR
00956
US

IV. Provider business mailing address

NISPERO 78 LADERAS DE SAN JUAN
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-792-4308
  • Fax:
Mailing address:
  • Phone: 787-474-8325
  • Fax: 787-287-5119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7282
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: