Healthcare Provider Details

I. General information

NPI: 1497700462
Provider Name (Legal Business Name): FABIO OLIVEROS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 04/24/2018
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: 863-385-7723
Mailing address:
  • Phone: 863-385-2606
  • Fax: 863-385-7723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME41053
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: