Provider Demographics
NPI:1831232727
Name:OLIVA, SUZANNE BEATTY (DOM)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:BEATTY
Last Name:OLIVA
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
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Mailing Address - Street 1:35 COYOTE SPGS
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-8083
Mailing Address - Country:US
Mailing Address - Phone:505-699-8116
Mailing Address - Fax:505-438-9484
Practice Address - Street 1:205 LOS ALAMOS HWY
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-3443
Practice Address - Country:US
Practice Address - Phone:505-699-8116
Practice Address - Fax:505-438-9484
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM353171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist