Healthcare Provider Details

I. General information

NPI: 1780872176
Provider Name (Legal Business Name): LIDIA OLIVEIRA, D.O., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 RINEHART RD STE 2001
LAKE MARY FL
32746-4802
US

IV. Provider business mailing address

PO BOX 22795
ORLANDO FL
32830-2795
US

V. Phone/Fax

Practice location:
  • Phone: 407-248-9003
  • Fax: 407-248-0445
Mailing address:
  • Phone: 407-248-9003
  • Fax: 407-248-0445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS6402
License Number StateFL

VIII. Authorized Official

Name: DR. LIDIA FLORES OLIVEIRA
Title or Position: PRESIDENT
Credential: D.O.
Phone: 407-248-9003