Provider Demographics
NPI:1033747993
Name:LIGGINS, NATHANIEL JR
Entity Type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:
Last Name:LIGGINS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1187 HOLSAPPLE WAY
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-1896
Mailing Address - Country:US
Mailing Address - Phone:925-234-0857
Mailing Address - Fax:
Practice Address - Street 1:1187 HOLSAPPLE WAY
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-1896
Practice Address - Country:US
Practice Address - Phone:925-234-0857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA805226163WX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0800XNursing Service ProvidersRegistered NurseOrthopedic