Healthcare Provider Details

I. General information

NPI: 1104820802
Provider Name (Legal Business Name): HELENA HELGA LIPTAKOVA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9870 GATEWAY BLVD N STE B7
EL PASO TX
79924-4425
US

IV. Provider business mailing address

PO BOX 593
WHITE SULPHUR SPRINGS WV
24986-0593
US

V. Phone/Fax

Practice location:
  • Phone: 915-751-5245
  • Fax: 915-751-5255
Mailing address:
  • Phone: 304-536-5030
  • Fax: 304-536-5031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberK0894
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: