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General NPI Number Information
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NPI Number | 1972453991
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Entity Type | Organization
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Legal Business Name | LICIAGA LLC
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Dates
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Enumeration Date | 01/29/2026
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Last Update Date | 01/29/2026
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Provider Practice Location Address
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Address Line | 1219 CALLE JULIAN BENGOCHEA URB SAN MARTIN
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City | SAN JUAN
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State | PR
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Zip | 00924-4445
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Country | US
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Telephone | 787-980-3414
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Fax |
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Provider Business Mailing Address
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Address Line | 1219 CALLE JULIAN BENGOCHEA
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City | SAN JUAN
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State | PR
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Zip | 00924-4445
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Country | US
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Telephone | 787-980-3414
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SYLMARIE A LICIAGA
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Credential | MD
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Telephone | 787-980-3414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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