Healthcare Provider Details

I. General information

NPI: 1750332664
Provider Name (Legal Business Name): JUAN ANDRES OLIVERO MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE SANCHEZ OSORIO 5X36
CAROLINA PR
00985
US

IV. Provider business mailing address

J2 VIA LLANURAS
SAN JUAN PR
00924-4479
US

V. Phone/Fax

Practice location:
  • Phone: 787-547-0944
  • Fax:
Mailing address:
  • Phone: 787-768-9518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8607
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: