Healthcare Provider Details

I. General information

NPI: 1124973094
Provider Name (Legal Business Name): OLLIE PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 SW 57TH AVE # 110
SOUTH MIAMI FL
33143-3845
US

IV. Provider business mailing address

6620 SW 57TH AVE # 110
SOUTH MIAMI FL
33143-3845
US

V. Phone/Fax

Practice location:
  • Phone: 305-845-9559
  • Fax: 305-468-6119
Mailing address:
  • Phone: 305-845-9559
  • Fax: 305-468-6119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: RAMSES RIVERO
Title or Position: CEO
Credential:
Phone: 305-607-7103