Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 0101255330 | VA |
Y | 208000000X | Pediatrician | 6155 | PR |
N | 2080A0000X | Adolescent Medicine | 6155 | PR |
N | 2080P0204X | Pediatric Emergency Doctor | 0101255330 | VA |
NPI | 1114922077 |
---|---|
Provider Name | Dr. Luis F. Olmedo |
First Address | Chesapeake, VA 23320-2855 |
Second Address | Chesapeake, VA 23320-2855 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 06/05/2016 |