Healthcare Provider Details

I. General information

NPI: 1780548826
Provider Name (Legal Business Name): CECILIA VIOLETA OLMO LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CECILIA VIOLETA OLMO-LOPEZ

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CALLE CASIA
SAN JUAN PR
00921-3201
US

IV. Provider business mailing address

URB BALDRICH CALLE PINTOR CAMPECHE 209
SAN JUAN PR
00918
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-7582
  • Fax:
Mailing address:
  • Phone: 787-696-1585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number6893342
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: