Provider Demographics
NPI:1972580280
Name:LIANGCO, CECILIA MARVILLA (MD)
Entity Type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:MARVILLA
Last Name:LIANGCO
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 1:625 SE 2ND AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-5065
Mailing Address - Country:US
Mailing Address - Phone:561-735-7733
Mailing Address - Fax:561-735-7739
Practice Address - Street 1:4821 BLUE PINE CIR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-7237
Practice Address - Country:US
Practice Address - Phone:561-735-7733
Practice Address - Fax:561-735-7739
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME28111208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL50853Medicare ID - Type UnspecifiedMEDICARE NUMBER
FLD55866Medicare UPIN