Provider Demographics
NPI:1851080675
Name:LIQUIDANO, MARIANA (PA)
Entity Type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:LIQUIDANO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COMPREHENSIVE PRIMARY CARE, LLC 3905 JOHNS CREEK COURT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2937
Mailing Address - Country:US
Mailing Address - Phone:678-888-2273
Mailing Address - Fax:
Practice Address - Street 1:COMPREHENSIVE PRIMARY CARE, LLC
Practice Address - Street 2:SUITE 200
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046
Practice Address - Country:US
Practice Address - Phone:678-888-2273
Practice Address - Fax:678-888-2273
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant