Provider Demographics
NPI:1912290255
Name:LANTIGUA, OLIERTI (CASE MANAGER)
Entity Type:Individual
Prefix:
First Name:OLIERTI
Middle Name:
Last Name:LANTIGUA
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:OLIERTI
Other - Middle Name:
Other - Last Name:FELIX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1290 GOLFVIEW AVE FL 4
Mailing Address - Street 2:ATTN: BILLING DEPARTMENT
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-6740
Mailing Address - Country:US
Mailing Address - Phone:863-519-7900
Mailing Address - Fax:863-519-7696
Practice Address - Street 1:1255 BRICE BLVD
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-6735
Practice Address - Country:US
Practice Address - Phone:863-519-8233
Practice Address - Fax:863-519-8304
Is Sole Proprietor?:No
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker