Provider Demographics
NPI:1255680948
Name:OLIVA-TRINCHET, NORBERTO AGUSTIN (BMO X- RAY)
Entity Type:Individual
Prefix:
First Name:NORBERTO
Middle Name:AGUSTIN
Last Name:OLIVA-TRINCHET
Suffix:
Gender:M
Credentials:BMO X- RAY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7124 SW 111TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2135
Mailing Address - Country:US
Mailing Address - Phone:786-290-0006
Mailing Address - Fax:305-593-8369
Practice Address - Street 1:7124 SW 111TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2135
Practice Address - Country:US
Practice Address - Phone:786-290-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBMO79930247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty