Provider Demographics
NPI:1346246865
Name:OLIVENCIA, HUMBERTO N (MD)
Entity Type:Individual
Prefix:DR
First Name:HUMBERTO
Middle Name:N
Last Name:OLIVENCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3125
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-3125
Mailing Address - Country:US
Mailing Address - Phone:787-834-3535
Mailing Address - Fax:787-832-3300
Practice Address - Street 1:14 CALLE PERAL N
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4861
Practice Address - Country:US
Practice Address - Phone:787-834-3535
Practice Address - Fax:787-832-3300
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR5555207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE-10355Medicare UPIN