Provider Demographics
NPI:1164843744
Name:OLIVENCIA HENRIQUEZ, ZAIRA TERESA (OD)
Entity Type:Individual
Prefix:DR
First Name:ZAIRA
Middle Name:TERESA
Last Name:OLIVENCIA HENRIQUEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB .REPTO. UNIVERSIDAD CALLE 4 L 24
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-3831
Mailing Address - Country:US
Mailing Address - Phone:787-677-4074
Mailing Address - Fax:
Practice Address - Street 1:281 CALLE RUIZ BELVIS
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-2335
Practice Address - Country:US
Practice Address - Phone:787-896-7040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-26
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR714152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist