Healthcare Provider Details

I. General information

NPI: 1831113067
Provider Name (Legal Business Name): LUIS OLIVA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9980 N. CENTRAL PARK BLVD. SUITE 202
BOCA RATON FL
33428-1762
US

IV. Provider business mailing address

9980 N. CENTRAL PARK BLVD. SUITE 202
BOCA RATON FL
33428-1762
US

V. Phone/Fax

Practice location:
  • Phone: 561-482-2092
  • Fax: 561-482-7038
Mailing address:
  • Phone: 561-482-2092
  • Fax: 561-482-7038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberME0059288
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: