Healthcare Provider Details

I. General information

NPI: 1114563574
Provider Name (Legal Business Name): ALEXANDRA OLIVO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2019
Last Update Date: 11/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 HAMPSHIRE ST
CAMBRIDGE MA
02139-1306
US

IV. Provider business mailing address

25 BRAINTREE HILL OFFICE PARK STE 101
BRAINTREE MA
02184-8715
US

V. Phone/Fax

Practice location:
  • Phone: 617-575-5570
  • Fax: 617-876-0217
Mailing address:
  • Phone: 781-971-5019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2319744
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: