=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306520291
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICARDO SARO OLIVA MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2023
-----------------------------------------------------
Last Update Date | 01/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1717 N BAYSHORE DR STE 217
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33132-1680
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-728-0505
-----------------------------------------------------
Fax | 305-728-0515
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7341 SW 109TH CT
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33173-2761
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-631-6459
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | ACN1581
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | ACN1581
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------