Provider Demographics
NPI:1578784617
Name:PEDRO T OLIVEROS JR MD PA
Entity Type:Organization
Organization Name:PEDRO T OLIVEROS JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:T
Authorized Official - Last Name:OLIVEROS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:407-265-2100
Mailing Address - Street 1:341 N MAITLAND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4783
Mailing Address - Country:US
Mailing Address - Phone:407-265-2100
Mailing Address - Fax:407-265-2872
Practice Address - Street 1:341 N MAITLAND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4783
Practice Address - Country:US
Practice Address - Phone:407-265-2100
Practice Address - Fax:407-265-2872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty