Healthcare Provider Details

I. General information

NPI: 1457986317
Provider Name (Legal Business Name): ALEJANDRO OLIVEROS NURSE PRACTITIONER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10130 SW 40TH ST
MIAMI FL
33165-3948
US

IV. Provider business mailing address

8333 NW 53RD ST FL 6
DORAL FL
33166-4783
US

V. Phone/Fax

Practice location:
  • Phone: 305-685-5688
  • Fax: 786-953-1893
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11001940
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: