Provider Demographics
NPI:1275635765
Name:OLAZABAL, BERTHA M (MD)
Entity Type:Individual
Prefix:DR
First Name:BERTHA
Middle Name:M
Last Name:OLAZABAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1435 W 49TH PL
Mailing Address - Street 2:SUITE 301
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3197
Mailing Address - Country:US
Mailing Address - Phone:305-557-2885
Mailing Address - Fax:305-557-2604
Practice Address - Street 1:1435 W 49TH PL
Practice Address - Street 2:SUITE 301
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3197
Practice Address - Country:US
Practice Address - Phone:305-557-2885
Practice Address - Fax:305-557-2604
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME53971207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063680100Medicaid
FL07949OtherBLUE CROSS / BLUE SHIELD
FL063680100Medicaid
FLE31254Medicare UPIN