MEDICARE: OLIVOS THERAPY HUB INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1154996213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLIVOS THERAPY HUB INC

Provider Business Mailing Address
First Line	:	801 NORTHPOINT PKWY STE 35
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-1991
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 NORTHPOINT PKWY STE 35
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-1991
Country	:	US
Telephone Number	:	786-872-9683
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	WILDER BARO FERNANDEZ
Credential	:
Telephone Number	:	786-872-9683

Provider Enumeration Date	:	05/21/2021
Last Update Date	:	06/04/2021

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Directions to “OLIVOS THERAPY HUB INC ” Practice Location

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