Healthcare Provider Details

I. General information

NPI: 1063144632
Provider Name (Legal Business Name): OLIVERO MEDICAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1243 SKYTOP MOUNTAIN RD
PORT MATILDA PA
16870-7725
US

IV. Provider business mailing address

1243 SKYTOP MOUNTAIN RD
PORT MATILDA PA
16870-7725
US

V. Phone/Fax

Practice location:
  • Phone: 814-499-3009
  • Fax: 814-584-5751
Mailing address:
  • Phone: 814-499-3009
  • Fax: 814-584-5751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL OLIVERO
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 814-499-3009