Provider Demographics
NPI:1134668171
Name:OLIVERAS, MOHANDAS
Entity Type:Individual
Prefix:
First Name:MOHANDAS
Middle Name:
Last Name:OLIVERAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:L8 CALLE 8
Mailing Address - Street 2:URB SAN JOSE BUZON 50
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637
Mailing Address - Country:US
Mailing Address - Phone:787-519-5404
Mailing Address - Fax:
Practice Address - Street 1:L8 CALLE 8
Practice Address - Street 2:URB SAN JOSE BUZON 50
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637-0000
Practice Address - Country:US
Practice Address - Phone:787-519-5404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1174224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant