Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 35.143209 | OH |
NPI | 1154608255 |
---|---|
Provider Name | Dr. Gabriel Alejandro Olivares Rodriguez |
First Address | Shaker Heights, OH 44122-3121 |
Second Address | Cleveland, OH 44195-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2011 |
Last Update Date | 15/09/2021 |