Provider Demographics
NPI:1497863807
Name:OLIVIERI, ODETTE (MD)
Entity Type:Individual
Prefix:
First Name:ODETTE
Middle Name:
Last Name:OLIVIERI
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:PO BOX 801217
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREZ
Mailing Address - State:PR
Mailing Address - Zip Code:00780
Mailing Address - Country:US
Mailing Address - Phone:787-396-1825
Mailing Address - Fax:787-813-1061
Practice Address - Street 1:URB INDUSTRIAL REPARADA
Practice Address - Street 2:ANA D PEREZ MARCHAND ST.
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731
Practice Address - Country:US
Practice Address - Phone:787-840-0297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11155208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics