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General NPI Number Information
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NPI Number | 1912896440
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Entity Type | Organization
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Legal Business Name | LIVERS PEDIATRIC LLC
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Dates
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Enumeration Date | 06/30/2025
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 99 CARRETERA #2 SUITE 108 SUCHVILLE PLAZA
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City | GUAYNABO
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State | PR
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Zip | 00966-2046
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Country | US
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Telephone | 787-314-5475
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Fax | 787-504-5005
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Provider Business Mailing Address
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Address Line | URB PRIMAVERA 78 PASEO DE LAS FLORES
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City | TRUJILLO ALTO
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State | PR
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Zip | 00976-6076
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Country | US
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Telephone | 787-314-5475
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC GASTROENTEROLOGIST
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Name | EMILLE REYES SANTIAGO
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Credential | MD
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Telephone | 787-314-5475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2080T0004X
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Taxonomy Name | Pediatric Transplant Hepatology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number |
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License Number State |
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