Provider Demographics
NPI:1053549550
Name:CORCIA, LIAT (MD)
Entity type:Individual
Prefix:
First Name:LIAT
Middle Name:
Last Name:CORCIA
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 1:4425 PONCE DE LEON BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-1837
Mailing Address - Country:US
Mailing Address - Phone:305-667-3152
Mailing Address - Fax:
Practice Address - Street 1:4425 PONCE DE LEON BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-1837
Practice Address - Country:US
Practice Address - Phone:305-667-3152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA240475208000000X
FL112450208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics