Provider Demographics
NPI:1912896440
Name:LIVERS PEDIATRIC LLC
Entity type:Organization
Organization Name:LIVERS PEDIATRIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC GASTROENTEROLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:EMILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-314-5475
Mailing Address - Street 1:PO BOX 16474
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00908-6474
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:99 CARRETERA #2 SUITE 108
Practice Address - Street 2:SUCHVILLE PLAZA
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966
Practice Address - Country:US
Practice Address - Phone:787-314-5475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-30
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080T0004XAllopathic & Osteopathic PhysiciansPediatricsPediatric Transplant HepatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1568613735OtherPHYSICIAN