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General NPI Number Information
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NPI Number | 1144389586
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Entity Type | Individual
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Provider Name | ELENA M LLIVINA MD
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Gender | Female
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 01/29/2010
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Provider Practice Location Address
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Address Line | 2000 STONEGATE TRL SUITE 112
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City | BIRMINGHAM
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State | AL
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Zip | 35242-2246
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Country | US
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Telephone | 205-977-9876
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Fax | 205-977-9876
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Provider Business Mailing Address
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Address Line | 2000 STONEGATE TRL SUITE 112
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City | BIRMINGHAM
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State | AL
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Zip | 35242-2246
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Country | US
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Telephone | 205-977-9876
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Fax | 205-977-9876
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 062913
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 29784
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License Number State | AL
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