Provider Demographics
NPI:1730431040
Name:LIWANAG, CHRISTOPHER PLORGO
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:PLORGO
Last Name:LIWANAG
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:CHRISTOPHER
Other - Middle Name:PLORGO
Other - Last Name:LIWANAG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:2601 CLAYMORE AVE
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-0911
Mailing Address - Country:US
Mailing Address - Phone:469-831-5042
Mailing Address - Fax:972-664-0003
Practice Address - Street 1:2100 N GREENVILLE AVE
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-4345
Practice Address - Country:US
Practice Address - Phone:972-664-0701
Practice Address - Fax:972-664-0003
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1212176174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist