Healthcare Provider Details

I. General information

NPI: 1912896440
Provider Name (Legal Business Name): LIVERS PEDIATRIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 CARRETERA #2 SUITE 108 SUCHVILLE PLAZA
GUAYNABO PR
00966-2046
US

IV. Provider business mailing address

URB PRIMAVERA 78 PASEO DE LAS FLORES
TRUJILLO ALTO PR
00976-6076
US

V. Phone/Fax

Practice location:
  • Phone: 787-314-5475
  • Fax: 787-504-5005
Mailing address:
  • Phone: 787-314-5475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080T0004X
TaxonomyPediatric Transplant Hepatology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: EMILLE REYES SANTIAGO
Title or Position: PEDIATRIC GASTROENTEROLOGIST
Credential: MD
Phone: 787-314-5475