Healthcare Provider Details

I. General information

NPI: 1497863807
Provider Name (Legal Business Name): ODETTE OLIVIERI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB INDUSTRIAL REPARADA ANA D PEREZ MARCHAND ST.
PONCE PR
00731
US

IV. Provider business mailing address

PO BOX 801217
COTO LAUREZ PR
00780
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-0297
  • Fax:
Mailing address:
  • Phone: 787-396-1825
  • Fax: 787-813-1061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11155
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: