=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831652544
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIV & EVE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2019
-----------------------------------------------------
Last Update Date | 04/09/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 937 COFFEE RD STE 800
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95355-4240
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-642-1506
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 577343
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95357-7343
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-642-2061
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | AMIRA PURTO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 209-642-2061
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 247200000X
-----------------------------------------------------
Taxonomy Name | Other Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------