Provider Demographics
NPI:1487030060
Name:LLIBOTT CONSULTORIOS MEDICOS- WS,PLLC
Entity Type:Organization
Organization Name:LLIBOTT CONSULTORIOS MEDICOS- WS,PLLC
Other - Org Name:LLIBOTT CONSULTORIOS MEDICOS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASURZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-792-1519
Mailing Address - Street 1:1145 SILAS CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-5627
Mailing Address - Country:US
Mailing Address - Phone:336-792-1515
Mailing Address - Fax:336-792-1518
Practice Address - Street 1:1145 SILAS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127
Practice Address - Country:US
Practice Address - Phone:336-792-1519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-05
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care