Provider Demographics
NPI:1568032795
Name:MONTIEL PAEZ, OLIVER JOSE MANUEL (SA-C)
Entity Type:Individual
Prefix:
First Name:OLIVER JOSE MANUEL
Middle Name:
Last Name:MONTIEL PAEZ
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8579 WHIPPORWILL DR APT C
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3660
Mailing Address - Country:US
Mailing Address - Phone:434-421-5403
Mailing Address - Fax:
Practice Address - Street 1:8579 WHIPPORWILL DR APT C
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3660
Practice Address - Country:US
Practice Address - Phone:434-421-5403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21-390246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant