Healthcare Provider Details

I. General information

NPI: 1396323986
Provider Name (Legal Business Name): AURORA GABRIELLE OLIVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 E ROLLING XRDS STE 55
CATONSVILLE MD
21228-6212
US

IV. Provider business mailing address

1 N MAIN ST
BEL AIR MD
21014-3592
US

V. Phone/Fax

Practice location:
  • Phone: 410-455-9660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number01804
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number01804
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC007178
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: