Provider Demographics
NPI:1881032720
Name:J OLIVIERI PROFESSIONAL HEALTH NETWORK LLC
Entity Type:Organization
Organization Name:J OLIVIERI PROFESSIONAL HEALTH NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:C
Authorized Official - Last Name:OLIVIERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-697-8580
Mailing Address - Street 1:5200 PAIGE RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-2121
Mailing Address - Country:US
Mailing Address - Phone:972-697-8580
Mailing Address - Fax:214-245-5915
Practice Address - Street 1:6300 SAMUELL BLVD
Practice Address - Street 2:STE 120
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-7137
Practice Address - Country:US
Practice Address - Phone:214-381-1910
Practice Address - Fax:214-381-2868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty