Provider Demographics
NPI:1427400811
Name:OLIVENCIA, ALEJANDRA
Entity Type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:
Last Name:OLIVENCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:589 AMSTERDAM AVE
Mailing Address - Street 2:APT. 2C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-2342
Mailing Address - Country:US
Mailing Address - Phone:646-732-9374
Mailing Address - Fax:
Practice Address - Street 1:589 AMSTERDAM AVE
Practice Address - Street 2:APT. 2C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-2342
Practice Address - Country:US
Practice Address - Phone:646-732-9374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator