Provider Demographics
NPI:1891203725
Name:ENAMORADO, OLVIN
Entity Type:Individual
Prefix:
First Name:OLVIN
Middle Name:
Last Name:ENAMORADO
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 1:10279 SW 227TH LN
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1751
Mailing Address - Country:US
Mailing Address - Phone:786-315-6954
Mailing Address - Fax:
Practice Address - Street 1:10279 SW 227TH LN
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190-1751
Practice Address - Country:US
Practice Address - Phone:786-315-6954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty