1639675887 NPI number — DR. MELANI BUENAVENTURA OLIVARES MD

Table of content: DR. MELANI BUENAVENTURA OLIVARES MD (NPI 1639675887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639675887 NPI number — DR. MELANI BUENAVENTURA OLIVARES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLIVARES
Provider First Name:
MELANI
Provider Middle Name:
BUENAVENTURA
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:
1639675887
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9B WINDLE PARK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TARRYTOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10591-3912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9B WINDLE PARK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TARRYTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10591-3912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-433-2803
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/04/2018

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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