Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 14666 | PR |
NPI | 1033113659 |
---|---|
Provider Name | Dr. Elvin Olivero |
First Address | San Juan, PR 00926 |
Second Address | San Juan, PR 00926-2229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2005 |
Last Update Date | 12/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H95484 | (02) | PR |