=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124973094
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OLLIE PEDIATRICS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2026
-----------------------------------------------------
Last Update Date | 03/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6620 SW 57TH AVE # 110
-----------------------------------------------------
City | SOUTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33143-3845
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-845-9559
-----------------------------------------------------
Fax | 305-468-6119
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6620 SW 57TH AVE # 110
-----------------------------------------------------
City | SOUTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33143-3845
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-845-9559
-----------------------------------------------------
Fax | 305-468-6119
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | RAMSES RIVERO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-607-7103
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------