Provider Demographics
NPI:1770848541
Name:O'NEILL, GENOVEVA OLLERVIDES (MD)
Entity Type:Individual
Prefix:
First Name:GENOVEVA
Middle Name:OLLERVIDES
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GENOVEVA
Other - Middle Name:
Other - Last Name:ORTIZ DE ROSAS OLLERVIDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 E 33RD ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-2776
Mailing Address - Country:US
Mailing Address - Phone:360-514-7550
Mailing Address - Fax:360-514-7553
Practice Address - Street 1:100 E 33RD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-2776
Practice Address - Country:US
Practice Address - Phone:360-514-7550
Practice Address - Fax:360-514-7553
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML 60290831207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine