Provider Demographics
NPI:1265308456
Name:LIVMED CLINIC LLC
Entity type:Organization
Organization Name:LIVMED CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:TAMAYO ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-404-2017
Mailing Address - Street 1:11980 SW 144TH CT STE 6
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-8601
Mailing Address - Country:US
Mailing Address - Phone:787-404-2017
Mailing Address - Fax:
Practice Address - Street 1:11980 SW 144TH CT STE 6
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-8601
Practice Address - Country:US
Practice Address - Phone:787-404-2017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-14
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty