Provider Demographics
NPI:1245908243
Name:FIOL OLIVERO, KATHERINE INDIRA (SA-C)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:INDIRA
Last Name:FIOL OLIVERO
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8221 RANCHVIEW DR APT 2023
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-7696
Mailing Address - Country:US
Mailing Address - Phone:214-584-9583
Mailing Address - Fax:
Practice Address - Street 1:8221 RANCHVIEW DR APT 2023
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-7696
Practice Address - Country:US
Practice Address - Phone:214-584-9583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21-478246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty