Provider Demographics
NPI:1477896199
Name:OLAVARRIETA, RAQUEL AURORA (MD)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:AURORA
Last Name:OLAVARRIETA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11459 NW 75TH LN
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2328
Mailing Address - Country:US
Mailing Address - Phone:305-322-6630
Mailing Address - Fax:
Practice Address - Street 1:11400 N KENDALL DR
Practice Address - Street 2:SUITE A-211
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1029
Practice Address - Country:US
Practice Address - Phone:305-274-2255
Practice Address - Fax:305-274-2211
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1272072080A0000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine