Provider Demographics
NPI:1033113659
Name:OLIVERO, ELVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ELVIN
Middle Name:
Last Name:OLIVERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE GLADIEL 3 PARK GARDENS
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-755-9050
Mailing Address - Fax:787-292-0130
Practice Address - Street 1:1 PARK CT
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-2229
Practice Address - Country:US
Practice Address - Phone:787-755-9050
Practice Address - Fax:787-292-0130
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14666208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR21853Medicare ID - Type UnspecifiedGENERAL MEDICINE
PRH95484Medicare UPIN