Provider Demographics
NPI:1083975866
Name:OVIEDO, SAUL (LPN)
Entity Type:Individual
Prefix:
First Name:SAUL
Middle Name:
Last Name:OVIEDO
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 GREENTREE RD
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2116
Mailing Address - Country:US
Mailing Address - Phone:631-987-8279
Mailing Address - Fax:
Practice Address - Street 1:39 GREENTREE RD
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2116
Practice Address - Country:US
Practice Address - Phone:631-987-8279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308828-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse