Healthcare Provider Details

I. General information

NPI: 1487327771
Provider Name (Legal Business Name): OLGA LUCIA PEREZ ESTRADA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2021
Last Update Date: 08/01/2021
Certification Date: 07/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 NE 36TH AVE
OCALA FL
34470-4931
US

IV. Provider business mailing address

3001 SE LAKE WEIR AVE APT 1010
OCALA FL
34471-6731
US

V. Phone/Fax

Practice location:
  • Phone: 352-732-4847
  • Fax:
Mailing address:
  • Phone: 952-688-9896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number27974
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: