Provider Demographics
NPI:1659807303
Name:OLIVA NODARSE, JANET
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:OLIVA NODARSE
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 1:10247 SW 24TH ST
Mailing Address - Street 2:APT D475
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2576
Mailing Address - Country:US
Mailing Address - Phone:786-320-3902
Mailing Address - Fax:
Practice Address - Street 1:10247 SW 24TH ST
Practice Address - Street 2:APT D475
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2576
Practice Address - Country:US
Practice Address - Phone:786-320-3902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician