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NPI Code Detail

MEDICARE: OLIVERA HEALTH GROUP IA LLC

MEDICARE: OLIVERA HEALTH GROUP IA LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1255192423
Entity Type Code : Organization
Provider Name (Legal Business Name) : OLIVERA HEALTH GROUP IA LLC
Provider Business Mailing Address
First Line : 199 LEE AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11211-8919
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6420 COUNCIL ST NE
Second Line :
City : CEDAR RAPIDS
State : IA
Zip : 52402-1129
Country : US
Telephone Number : 212-734-6621
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MENACHEM HOFFMAN
Credential :
Telephone Number : 917-345-9464
Provider Enumeration Date : 01/16/2024
Last Update Date : 04/03/2024

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Directions to “OLIVERA HEALTH GROUP IA LLC ” Practice Location

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