Provider Demographics
NPI:1821252057
Name:PIOVANETTI, OMAR N (MD)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:N
Last Name:PIOVANETTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:OMAR
Other - Middle Name:N
Other - Last Name:PIOVANETTI PEREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 10431
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-0431
Mailing Address - Country:US
Mailing Address - Phone:787-781-3020
Mailing Address - Fax:787-782-9524
Practice Address - Street 1:1250 AVE JESUS T PINERO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-1616
Practice Address - Country:US
Practice Address - Phone:787-781-3020
Practice Address - Fax:787-782-9524
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17373207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology