MEDICARE: YELENA OLIVA FERNANDEZ SURGICAL ASSISTANT

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	246ZC0007X	Surgical Assistant	23-496	FL

General Provider Information

NPI Number	:	1821770611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YELENA OLIVA FERNANDEZ SURGICAL ASSISTANT

Provider Business Mailing Address
First Line	:	4169 MADISON ST
Second Line	:
City	:	AVE MARIA
State	:	FL
Zip	:	34142-5019
Country	:	US
Telephone Number	:	239-692-1434
Fax Number	:

Provider Business Practice Location Address
First Line	:	4169 MADISON ST
Second Line	:
City	:	AVE MARIA
State	:	FL
Zip	:	34142-5019
Country	:	US
Telephone Number	:	239-692-1434
Fax Number	:

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

Provider Enumeration Date	:	08/02/2023
Last Update Date	:	08/02/2023

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