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NPI Code Detail

MEDICARE: OLIVIA TIBERIA

MEDICARE: OLIVIA TIBERIA
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1972493229
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLIVIA TIBERIA
Provider Business Mailing Address
First Line : 203 12TH ST
Second Line :
City : WATKINS GLEN
State : NY
Zip : 14891-1617
Country : US
Telephone Number : 607-535-6934
Fax Number : 607-535-2666
Provider Business Practice Location Address
First Line : 203 12TH ST
Second Line :
City : WATKINS GLEN
State : NY
Zip : 14891-1617
Country : US
Telephone Number : 607-535-6934
Fax Number : 607-535-2666
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2025
Last Update Date : 07/08/2025

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Directions to “ OLIVIA TIBERIA ” Practice Location

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