Provider Demographics
NPI:1528181799
Name:OLIVER, JOSE L (MD,MPH,OM)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:L
Last Name:OLIVER
Suffix:
Gender:M
Credentials:MD,MPH,OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MANSIONES MONTE VERDE 169
Mailing Address - Street 2:PRECIOSA ST
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-4161
Mailing Address - Country:US
Mailing Address - Phone:787-948-3651
Mailing Address - Fax:787-767-3968
Practice Address - Street 1:HOSPITAL INDUSTRIAL - CENTRO MEDICO
Practice Address - Street 2:BO. MONACILLOS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936
Practice Address - Country:US
Practice Address - Phone:787-764-3260
Practice Address - Fax:787-767-3968
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR25282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4682OtherSTATE LICENSE
AO6962523OtherFEDERAL NARCOTICS LICENSE
PR03359DM-7OtherNARCOTICS STATE LICENSE