Provider Demographics
NPI:1174330427
Name:OLIVERA, YEINET (PA)
Entity type:Individual
Prefix:
First Name:YEINET
Middle Name:
Last Name:OLIVERA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13622 SW 119TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4525
Mailing Address - Country:US
Mailing Address - Phone:305-753-1449
Mailing Address - Fax:
Practice Address - Street 1:9900 SW 107TH AVE STE 200B
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2809
Practice Address - Country:US
Practice Address - Phone:786-332-1585
Practice Address - Fax:305-675-0343
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2407-PA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine