Provider Demographics
NPI:1073183455
Name:LIBETARIO, WILLIAM MERCURIO JR (RN)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:MERCURIO
Last Name:LIBETARIO
Suffix:JR
Gender:M
Credentials:RN
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Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
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Mailing Address - Fax:
Practice Address - Street 1:757 WESTWOOD PLZ STE 3325
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-2526
Practice Address - Country:US
Practice Address - Phone:310-267-8678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2023-09-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA95002108367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered