Healthcare Provider Details

I. General information

NPI: 1104766658
Provider Name (Legal Business Name): MARIELIZ NICOLE OLIVENCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 AVE RAMON LUIS RIVERA
BAYAMON PR
00959-5560
US

IV. Provider business mailing address

URB ALTURAS DE FLAMBOYAN V9 CALLE 12
BAYAMON PR
00959
US

V. Phone/Fax

Practice location:
  • Phone: 787-787-9033
  • Fax:
Mailing address:
  • Phone: 787-233-6370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number17257
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: