Provider Demographics
NPI:1689942112
Name:OLIVA, ARLENE V (MD)
Entity Type:Individual
Prefix:
First Name:ARLENE
Middle Name:V
Last Name:OLIVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:954-971-3210
Mailing Address - Fax:954-971-3427
Practice Address - Street 1:4570 LYONS RD STE 110
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-3481
Practice Address - Country:US
Practice Address - Phone:954-971-3210
Practice Address - Fax:954-971-3427
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 115549208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008500100Medicaid