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General NPI Number Information
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NPI Number | 1942266580
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Entity Type | Individual
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Provider Name | MARIA THERESA LIQUETE MD
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Gender | Female
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Dates
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Enumeration Date | 04/22/2006
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 2460 CURTIS ELLIS DR
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-2237
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Country | US
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Telephone | 252-962-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 220 STANDIFORD AVE STE F
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City | MODESTO
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State | CA
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Zip | 95350-1159
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Country | US
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Telephone | 812-604-5870
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Fax | 209-579-5637
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 2016-00646
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 39490
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | C131074
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0101244357
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License Number State | VA
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