Provider Demographics
NPI:1578603262
Name:OLIVERA, VANESSA MARIA
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:MARIA
Last Name:OLIVERA
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 1:279 CALLE FERNANDEZ GARCIA
Mailing Address - Street 2:
Mailing Address - City:LUQUILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00773-2222
Mailing Address - Country:US
Mailing Address - Phone:787-889-3066
Mailing Address - Fax:787-889-3066
Practice Address - Street 1:279 CALLE FERNANDEZ GARCIA
Practice Address - Street 2:
Practice Address - City:LUQUILLO
Practice Address - State:PR
Practice Address - Zip Code:00773-2222
Practice Address - Country:US
Practice Address - Phone:787-889-3066
Practice Address - Fax:787-889-3066
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4250183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician