Provider Demographics
NPI:1710635958
Name:OLIVA, LIZ B (NP)
Entity Type:Individual
Prefix:
First Name:LIZ
Middle Name:B
Last Name:OLIVA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LIZ
Other - Middle Name:B
Other - Last Name:OLIVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:7119 W 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-5286
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7119 W 31ST AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-5286
Practice Address - Country:US
Practice Address - Phone:786-452-6521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-16
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9393242261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care