Healthcare Provider Details

I. General information

NPI: 1376668731
Provider Name (Legal Business Name): WILFREDO OLMO-MARTINEZ MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CALLE CASIA
SAN JUAN PR
00921-3200
US

IV. Provider business mailing address

PO BOX 33042
SAN JUAN PR
00933-3042
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-7582
  • Fax: 787-641-4398
Mailing address:
  • Phone: 787-789-0084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5046
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: