1174712970 NPI number — BLESSILDA B. LIU M.D., P.A.

Table of content: (NPI 1174712970)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174712970 NPI number — BLESSILDA B. LIU M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLESSILDA B. LIU M.D., P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174712970
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2623 N FOREST RIDGE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HERNANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34442-5123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-746-4684
Provider Business Mailing Address Fax Number:
352-746-5784

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2623 N FOREST RIDGE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HERNANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34442-5123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-746-4684
Provider Business Practice Location Address Fax Number:
352-746-5784
Provider Enumeration Date:
10/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LIU
Authorized Official First Name:
BLESSILDA
Authorized Official Middle Name:
BOHOLST
Authorized Official Title or Position:
INTERNAL MEDICINE
Authorized Official Telephone Number:
352-746-4684

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME0072471 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ME0072471 . This is a "LISCENCE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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