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General NPI Number Information
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NPI Number | 1730431040
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Entity Type | Individual
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Provider Name | MR. CHRISTOPHER PLORGO LIWANAG
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Gender | Male
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Dates
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Enumeration Date | 10/10/2012
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Last Update Date | 10/10/2012
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Provider Practice Location Address
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Address Line | 2100 N GREENVILLE AVE
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City | RICHARDSON
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State | TX
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Zip | 75082-4345
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Country | US
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Telephone | 972-664-0701
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Fax | 972-664-0003
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Provider Business Mailing Address
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Address Line | 2601 CLAYMORE AVE
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City | GARLAND
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State | TX
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Zip | 75043-0911
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Country | US
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Telephone | 469-831-5042
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Fax | 972-664-0003
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 1212176
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License Number State | TX
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