Provider Demographics
NPI:1437766391
Name:OLIVA, RAQUEL E (RBT)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:E
Last Name:OLIVA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 PEACEFUL PALM ST
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-6375
Mailing Address - Country:US
Mailing Address - Phone:813-508-8755
Mailing Address - Fax:
Practice Address - Street 1:2005 PEACEFUL PALM ST
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-6375
Practice Address - Country:US
Practice Address - Phone:813-508-8755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLO410725685280106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician