Provider Demographics
NPI:1760896286
Name:OLIVA-RASULO, LILLIAN
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:OLIVA-RASULO
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 1:14 WESTVIEW AVE
Mailing Address - Street 2:APT 209
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707
Mailing Address - Country:US
Mailing Address - Phone:914-439-2383
Mailing Address - Fax:914-948-0887
Practice Address - Street 1:14 WESTVIEW AVE
Practice Address - Street 2:APT 209
Practice Address - City:TUCKAHOE
Practice Address - State:NY
Practice Address - Zip Code:10707-4153
Practice Address - Country:US
Practice Address - Phone:914-439-2383
Practice Address - Fax:914-948-0887
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist