Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 23688 | CO |
NPI | 1346371994 |
---|---|
Provider Name | Mario M Oliveira |
First Address | Colorado Springs, CO 80909-5663 |
Second Address | Colorado Springs, CO 80909-5663 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D24308 | (02) | CO |