Provider Demographics
NPI:1003697442
Name:OLIVERAS, DAVID (TAC-III-05-20-9071)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:OLIVERAS
Suffix:
Gender:M
Credentials:TAC-III-05-20-9071
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CALLE EL VIGIA
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-2987
Mailing Address - Country:US
Mailing Address - Phone:787-709-2329
Mailing Address - Fax:
Practice Address - Street 1:71 CALLE VIVES
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-3887
Practice Address - Country:US
Practice Address - Phone:787-709-2329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTAC-III-05-20-9071101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)