1265484307 NPI number — DR. LYNETTE I OLIVER MD

Table of content: DR. LYNETTE I OLIVER MD (NPI 1265484307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265484307 NPI number — DR. LYNETTE I OLIVER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLIVER
Provider First Name:
LYNETTE
Provider Middle Name:
I
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1265484307
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3205 AVE ISLA VERDE
Provider Second Line Business Mailing Address:
GALAXY CONDOMINIUM APT. 802
Provider Business Mailing Address City Name:
CAROLINA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00979-4924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-268-7632
Provider Business Mailing Address Fax Number:
787-268-7632

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3205 AVE ISLA VERDE
Provider Second Line Business Practice Location Address:
GALAXY CONDOMINIUM APT. 802
Provider Business Practice Location Address City Name:
CAROLINA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00979-4924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-268-7632
Provider Business Practice Location Address Fax Number:
787-268-7632
Provider Enumeration Date:
05/17/2006

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: 207P00000X , with the licence number:  137613 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 137613 . This is a "NEW YORK LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 038377 . This is a "CT LICENSE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 015199 . This is a "ME LICENSE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 6404 . This is a "LICENCE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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