Provider Demographics
NPI:1326483959
Name:OLIVO GONZALEZ, NELGY (NELGY OLIVO GONZALEZ)
Entity Type:Individual
Prefix:
First Name:NELGY
Middle Name:
Last Name:OLIVO GONZALEZ
Suffix:
Gender:F
Credentials:NELGY OLIVO GONZALEZ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4833 TOMMANS TRL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-0760
Mailing Address - Country:US
Mailing Address - Phone:919-737-5600
Mailing Address - Fax:
Practice Address - Street 1:1310 N MAIN ST
Practice Address - Street 2:102
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4244
Practice Address - Country:US
Practice Address - Phone:407-780-2085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator