Provider Demographics
NPI:1194042556
Name:L.A. OLIVERIO,MD ENTERPRISES, INC.
Entity Type:Organization
Organization Name:L.A. OLIVERIO,MD ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SECRETARY AND DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:L.
Authorized Official - Middle Name:A
Authorized Official - Last Name:OLIVERIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-489-2401
Mailing Address - Street 1:20661 NED LOVE AVE
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34431-6767
Mailing Address - Country:US
Mailing Address - Phone:352-489-2401
Mailing Address - Fax:352-489-2521
Practice Address - Street 1:20661 NED LOVE AVE
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34431-6767
Practice Address - Country:US
Practice Address - Phone:352-489-2401
Practice Address - Fax:352-489-2521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47193208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063686000Medicaid
FLD86268Medicare UPIN