Healthcare Provider Details

I. General information

NPI: 1003147158
Provider Name (Legal Business Name): FABIO OLIVEROS & ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2010
Last Update Date: 01/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 MEDICAL CENTER AVE
SEBRING FL
33870-5463
US

IV. Provider business mailing address

130 MEDICAL CENTER AVE
SEBRING FL
33870-5463
US

V. Phone/Fax

Practice location:
  • Phone: 863-385-2606
  • Fax: 863-382-0184
Mailing address:
  • Phone: 863-385-2606
  • Fax: 863-382-0184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME93285
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME94328
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME103963
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME0041053
License Number StateFL

VIII. Authorized Official

Name: FABIO OLIVEROS
Title or Position: OWNER
Credential: M.D.
Phone: 863-385-2606