Healthcare Provider Details

I. General information

NPI: 1477896199
Provider Name (Legal Business Name): RAQUEL AURORA OLAVARRIETA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 04/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11400 N KENDALL DR SUITE A-211
MIAMI FL
33176-1029
US

IV. Provider business mailing address

11459 NW 75TH LN
MEDLEY FL
33178-2328
US

V. Phone/Fax

Practice location:
  • Phone: 305-274-2255
  • Fax: 305-274-2211
Mailing address:
  • Phone: 305-322-6630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME127207
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME127207
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: