Provider Demographics
NPI:1063282580
Name:LIBERAL, EMMANUEL
Entity type:Individual
Prefix:MR
First Name:EMMANUEL
Middle Name:
Last Name:LIBERAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5489 27TH PL SW
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34116-7513
Mailing Address - Country:US
Mailing Address - Phone:754-265-4720
Mailing Address - Fax:
Practice Address - Street 1:2045 DELLA DRIVE
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34117
Practice Address - Country:US
Practice Address - Phone:754-265-4720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL164-200-82-188-0172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver