Provider Demographics
NPI:1437663176
Name:OLIVA CRESPO, LUIS ERNESTO
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ERNESTO
Last Name:OLIVA CRESPO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7523 W 32ND LN
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-1704
Mailing Address - Country:US
Mailing Address - Phone:305-458-6616
Mailing Address - Fax:
Practice Address - Street 1:7523 W 32ND LN
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-1704
Practice Address - Country:US
Practice Address - Phone:305-458-6616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician