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General NPI Number Information
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NPI Number | 1982995635
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Entity Type | Organization
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Legal Business Name | BRENT R. LIVINGSTON, M.D., INC.
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Dates
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Enumeration Date | 04/28/2011
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Last Update Date | 01/04/2012
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Provider Practice Location Address
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Address Line | 3003 HEALTH CENTER DR
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City | SAN DIEGO
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State | CA
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Zip | 92123-2700
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Country | US
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Telephone | 858-939-3400
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8403
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City | RANCHO SANTA FE
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State | CA
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Zip | 92067-8403
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Country | US
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Telephone | 619-540-4180
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BRENT R. LIVINGSTON
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Credential | M.D.
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Telephone | 619-540-4180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | G24378
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License Number State | CA
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