MEDICARE: OLIVIA ANDINO

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	2255A2300X	Athletic Trainer
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1770375669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA ANDINO

Provider Business Mailing Address
First Line	:	4360 FACULTY LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-6601
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4226 MARTIN LUTHER KING BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77204-3071
Country	:	US
Telephone Number	:	713-743-2255
Fax Number	:

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

Provider Enumeration Date	:	05/19/2025
Last Update Date	:	05/19/2025

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Directions to “ OLIVIA ANDINO ” Practice Location

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