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General NPI Number Information
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NPI Number | 1578618088
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Entity Type | Organization
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Legal Business Name | OLIVERIO MEDICAL GROUP
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 09/11/2012
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Provider Practice Location Address
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Address Line | 330 W RAMSEY ST
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City | BANNING
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State | CA
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Zip | 92220-4823
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Country | US
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Telephone | 951-849-1950
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Fax | 951-849-0080
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Provider Business Mailing Address
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Address Line | 330 W RAMSEY ST
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City | BANNING
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State | CA
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Zip | 92220-4823
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Country | US
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Telephone | 951-849-1950
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Fax | 951-849-0080
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOY M OLIVERIO
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Credential |
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Telephone | 951-849-1950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 00A332270
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 00A450420
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License Number State | CA
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