Provider Demographics
NPI:1023689973
Name:LIVEFREELY INC
Entity type:Organization
Organization Name:LIVEFREELY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-981-5577
Mailing Address - Street 1:167 BANGOR AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3602
Mailing Address - Country:US
Mailing Address - Phone:408-981-5577
Mailing Address - Fax:
Practice Address - Street 1:4820 HARWOOD RD STE 200
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-5273
Practice Address - Country:US
Practice Address - Phone:408-981-5577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA4757579OtherDRIVERS LICENSE