Provider Demographics
NPI:1437925278
Name:MACE, LIBERTY PUYAL (IMT (ASCPI))
Entity Type:Individual
Prefix:MRS
First Name:LIBERTY
Middle Name:PUYAL
Last Name:MACE
Suffix:
Gender:F
Credentials:IMT (ASCPI)
Other - Prefix:MS
Other - First Name:LIBERTY
Other - Middle Name:VILLANUEVA
Other - Last Name:PUYAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:IMT (ASCPI)
Mailing Address - Street 1:1931 ALCO AVE
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-4353
Mailing Address - Country:US
Mailing Address - Phone:509-899-8120
Mailing Address - Fax:
Practice Address - Street 1:401 W POPLAR ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2846
Practice Address - Country:US
Practice Address - Phone:509-897-5722
Practice Address - Fax:509-522-5724
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist