Provider Demographics
NPI:1730609017
Name:GAYOSO LIVIAC, MIRTHA GIULIANA (MD)
Entity type:Individual
Prefix:
First Name:MIRTHA
Middle Name:GIULIANA
Last Name:GAYOSO LIVIAC
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 1:1417 S CLIFF AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1014
Mailing Address - Country:US
Mailing Address - Phone:605-322-3666
Mailing Address - Fax:
Practice Address - Street 1:1417 S CLIFF AVE STE 10
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1014
Practice Address - Country:US
Practice Address - Phone:605-322-3666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD143372080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology