Provider Demographics
NPI:1932837838
Name:CLINICA OLIVA SERVICIOS PSICOLOGICOS LLC
Entity Type:Organization
Organization Name:CLINICA OLIVA SERVICIOS PSICOLOGICOS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANANGER
Authorized Official - Prefix:
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MONTALVO-GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-510-7400
Mailing Address - Street 1:99 CALLE ESTEBAN PADILLA
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-6703
Mailing Address - Country:US
Mailing Address - Phone:787-510-7400
Mailing Address - Fax:
Practice Address - Street 1:99 CALLE ESTEBAN PADILLA
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-6703
Practice Address - Country:US
Practice Address - Phone:787-510-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-10
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty