Provider Demographics
NPI:1790112233
Name:OLIVA, DIANE (AP, DOM)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:OLIVA
Suffix:
Gender:F
Credentials:AP, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7028 MINDELLO ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33143-6232
Mailing Address - Country:US
Mailing Address - Phone:305-632-5351
Mailing Address - Fax:
Practice Address - Street 1:7028 MINDELLO ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33143-6232
Practice Address - Country:US
Practice Address - Phone:305-632-5351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3333171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist