Provider Demographics
NPI:1679756951
Name:LIWANAG, PROSPIL CALUMPIANO (MD)
Entity Type:Individual
Prefix:DR
First Name:PROSPIL
Middle Name:CALUMPIANO
Last Name:LIWANAG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 STALLION ST SW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-4840
Mailing Address - Country:US
Mailing Address - Phone:505-417-2297
Mailing Address - Fax:
Practice Address - Street 1:2204 STALLION ST SW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-4840
Practice Address - Country:US
Practice Address - Phone:505-417-2297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRS2007-0675207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine