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General NPI Number Information
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NPI Number | 1902036031
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Entity Type | Individual
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Provider Name | BERNARDO LOMBO LIEVANO M.D
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Gender | Male
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Dates
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Enumeration Date | 07/23/2009
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Last Update Date | 12/24/2015
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Provider Practice Location Address
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Address Line | 333 CEDAR ST
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City | NEW HAVEN
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State | CT
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Zip | 06510-3206
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Country | US
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Telephone | 203-785-4114
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Fax |
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Provider Business Mailing Address
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Address Line | 2307 MAPLE TREE LN
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City | EAST LYME
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State | CT
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Zip | 06333-1683
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Country | US
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Telephone | 203-804-0255
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Fax |
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 53648
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License Number State | CT
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