Provider Demographics
NPI:1275642985
Name:OLAZABAL, RICARDO MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:MANUEL
Last Name:OLAZABAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ARTURO RIVERA STREET # C-6
Mailing Address - Street 2:GARDEN HILLS
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966
Mailing Address - Country:US
Mailing Address - Phone:787-529-0656
Mailing Address - Fax:
Practice Address - Street 1:SOMASCAN, JOSE MARTI STREET #56
Practice Address - Street 2:FLORAL PARK
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-759-7878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12674174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8-9321Medicare ID - Type UnspecifiedPROVIDER NUMBER PARTICIPA