Healthcare Provider Details

I. General information

NPI: 1255680948
Provider Name (Legal Business Name): NORBERTO AGUSTIN OLIVA-TRINCHET BMO X- RAY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7124 SW 111TH PL
MIAMI FL
33173-2135
US

IV. Provider business mailing address

7124 SW 111TH PL
MIAMI FL
33173-2135
US

V. Phone/Fax

Practice location:
  • Phone: 786-290-0006
  • Fax:
Mailing address:
  • Phone: 786-290-0006
  • Fax: 305-593-8369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License NumberBMO79930
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: