Liberation, LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

OTC5977 Issued in AZ

Legal business name

LIBERATION, LLC

Practice address

802 N. 5TH
Pnoenix, AZ 85003-1316

Phone

(602) 708-9014

Fax

(888) 349-1581

NPI assigned

Mar 4, 2014

Last updated

Mar 4, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Adeola Adelayo, M.D

Title

Ceo

Phone

(602) 708-9014

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1393891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1393891200000",
    "number": "1518382274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "802 N 5TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850031316",
            "telephone_number": "602-559-4922",
            "fax_number": "888-349-1581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 N. 5TH",
            "city": "PNOENIX",
            "state": "AZ",
            "postal_code": "850031316",
            "telephone_number": "602-708-9014",
            "fax_number": "888-349-1581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-04",
        "last_updated": "2014-03-04",
        "status": "A",
        "authorized_official_last_name": "ADELAYO",
        "authorized_official_first_name": "ADEOLA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "602-708-9014",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "AZ",
            "license": "OTC5977",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.