Individual
DR. LIAUTAUD MORIN PROPHETE SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
502 WASHINGTON AVE, LOS BANOS, CA 93635-4649
(209) 826-4771
(209) 826-8565
Mailing address
502 WASHINGTON AVE, LOS BANOS, CA 93635-4649
(209) 826-4771
(209) 826-8565
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
20A9842
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00AX98420
—
CA
05
—
01239531
—
MS
Enumeration date
10/12/2006
Last updated
07/21/2022
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