1689603169 NPI number — DR. LUIS OLIVARI M.D.

Table of content: DR. LUIS OLIVARI M.D. (NPI 1689603169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689603169 NPI number — DR. LUIS OLIVARI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLIVARI
Provider First Name:
LUIS
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689603169
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 CARR 8177
Provider Second Line Business Mailing Address:
SUITE 26, PMB 226
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00966-3733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-273-8053
Provider Business Mailing Address Fax Number:
787-781-4555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
T3-9 CALLE SANDALIO ALONSO
Provider Second Line Business Practice Location Address:
LAS LOMAS
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00921-3632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-273-8053
Provider Business Practice Location Address Fax Number:
787-781-4555
Provider Enumeration Date:
06/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X , with the licence number:  6080 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 97553 . This is a "TRIPLE S, INC. (SSS)" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 52-06080 . This is a "PLAN DE SALUD U.I.A." identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 600098 . This is a "MMM HEALTH CARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 2518 . This is a "IMC (FIRST MEDICAL)" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 9220032 . This is a "HUMANA INSURANCE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 224062 . This is a "PREFERRED HEALTH CARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 066079 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: SE-0548 . This is a "PALIC PROVIDER NETWORK" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 4087 . This is a "PMC MEDICARE CHOICE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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