Provider Demographics
NPI:1053660662
Name:JOHN LIQUETE MD INC
Entity Type:Organization
Organization Name:JOHN LIQUETE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LIQUETE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-697-1150
Mailing Address - Street 1:14114 BUSINESS CENTER DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-9113
Mailing Address - Country:US
Mailing Address - Phone:951-697-1150
Mailing Address - Fax:
Practice Address - Street 1:14114 BUSINESS CENTER DR
Practice Address - Street 2:SUITE D
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-9113
Practice Address - Country:US
Practice Address - Phone:951-697-1150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49014207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty