Provider Demographics
NPI:1720045198
Name:DAVID J. OLIVERI, M.D., PC
Entity Type:Organization
Organization Name:DAVID J. OLIVERI, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:OLIVERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-778-9300
Mailing Address - Street 1:PO BOX 370183
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89137-0183
Mailing Address - Country:US
Mailing Address - Phone:702-778-9300
Mailing Address - Fax:702-778-9301
Practice Address - Street 1:851 S RAMPART BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-4882
Practice Address - Country:US
Practice Address - Phone:702-778-9300
Practice Address - Fax:702-778-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100502158Medicaid
NVV30838Medicare PIN
NV100502158Medicaid