MEDICARE: NORBERTO AGUSTIN OLIVA-TRINCHET BMO X- RAY

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	247100000X	Radiologic Technologist	BMO79930	FL

General Provider Information

NPI Number	:	1255680948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NORBERTO AGUSTIN OLIVA-TRINCHET BMO X- RAY

Provider Business Mailing Address
First Line	:	7124 SW 111TH PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-2135
Country	:	US
Telephone Number	:	786-290-0006
Fax Number	:	305-593-8369

Provider Business Practice Location Address
First Line	:	7124 SW 111TH PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-2135
Country	:	US
Telephone Number	:	786-290-0006
Fax Number	:

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

Provider Enumeration Date	:	09/10/2012
Last Update Date	:	09/10/2012

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Directions to “ NORBERTO AGUSTIN OLIVA-TRINCHET BMO X- RAY” Practice Location

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