Provider Demographics
NPI:1063408524
Name:LIVA, ENRICO (ND)
Entity type:Individual
Prefix:
First Name:ENRICO
Middle Name:
Last Name:LIVA
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CROMWELL CT
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-2510
Mailing Address - Country:US
Mailing Address - Phone:860-306-4045
Mailing Address - Fax:
Practice Address - Street 1:11 CROMWELL CT
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-2510
Practice Address - Country:US
Practice Address - Phone:860-306-4045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175F00000X
CT00061175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath