Provider Demographics
NPI:1861669889
Name:CITRUS INFECTIOUS DISEASE LLC
Entity Type:Organization
Organization Name:CITRUS INFECTIOUS DISEASE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUSTINE
Authorized Official - Middle Name:O
Authorized Official - Last Name:LIU-YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-417-0238
Mailing Address - Street 1:PO BOX 72
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34423-0072
Mailing Address - Country:US
Mailing Address - Phone:352-417-0238
Mailing Address - Fax:352-794-3146
Practice Address - Street 1:760 SE 5TH TER
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-4852
Practice Address - Country:US
Practice Address - Phone:352-417-0238
Practice Address - Fax:352-794-3146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100412261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty