Healthcare Provider Details

I. General information

NPI: 1619456407
Provider Name (Legal Business Name): ALICIA OLAVE-PICHON MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 2 KM 11.0
BAYAMON PR
00959
US

IV. Provider business mailing address

CALLE 73 SANTA CATALINA APARTMENTS TOWER II APT 105
BAYAMON PR
00961-4576
US

V. Phone/Fax

Practice location:
  • Phone: 787-474-8282
  • Fax:
Mailing address:
  • Phone: 773-966-8370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number33891-R
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: