MEDICARE: DR. CECILIA C. OLAZAR M.D.

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	174400000X	Specialist	51858	FL

General Provider Information

NPI Number	:	1184621229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CECILIA C. OLAZAR M.D.

Provider Business Mailing Address
First Line	:	130 PROFESSIONAL DR
Second Line	:
City	:	PONTE VEDRA
State	:	FL
Zip	:	32082-6216
Country	:	US
Telephone Number	:	904-285-1113
Fax Number	:	904-285-3110

Provider Business Practice Location Address
First Line	:	130 PROFESSIONAL DR
Second Line	:
City	:	PONTE VEDRA
State	:	FL
Zip	:	32082-6216
Country	:	US
Telephone Number	:	904-285-1113
Fax Number	:	904-285-3110

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	01/12/2011

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