Provider Demographics
NPI:1518317510
Name:OLIVA, LOURDES TERESITA
Entity Type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:TERESITA
Last Name:OLIVA
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 1:275 FONTAINEBLEAU BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-4500
Mailing Address - Country:US
Mailing Address - Phone:305-551-3003
Mailing Address - Fax:
Practice Address - Street 1:275 FONTAINEBLEAU BLVD STE 120
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-4500
Practice Address - Country:US
Practice Address - Phone:305-551-3003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health