Provider Demographics
NPI:1790201291
Name:OLIVERO, MIGUEL RAFAEL
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:RAFAEL
Last Name:OLIVERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 SE 59TH ST APT 213
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73129-5703
Mailing Address - Country:US
Mailing Address - Phone:405-537-7026
Mailing Address - Fax:
Practice Address - Street 1:9210 S WESTERN AVE STE A21
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-4982
Practice Address - Country:US
Practice Address - Phone:405-703-8755
Practice Address - Fax:405-895-7544
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)