Healthcare Provider Details

I. General information

NPI: 1255169850
Provider Name (Legal Business Name): NEFTALI OLMEDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ESTANCIAS DE BLVD 7000 PR844 APT131
SAN JUAN PR
00926
US

IV. Provider business mailing address

ESTANCIAS DE BLVD 7000 PR844 APT131
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-689-5666
  • Fax:
Mailing address:
  • Phone: 787-689-5666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number24628
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: