Provider Demographics
NPI:1760666796
Name:OLIVA & OLIVA MDS PA
Entity Type:Organization
Organization Name:OLIVA & OLIVA MDS PA
Other - Org Name:TAMPA BAY DIAGNOSTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:OLIVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-689-2853
Mailing Address - Street 1:1439 OAKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-2801
Mailing Address - Country:US
Mailing Address - Phone:813-689-2853
Mailing Address - Fax:813-654-1722
Practice Address - Street 1:1439 OAKFIELD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-2801
Practice Address - Country:US
Practice Address - Phone:813-689-2853
Practice Address - Fax:813-654-1722
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OLIVA & OLIVA MDS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0036108207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL77314Medicare PIN