Provider Demographics
NPI:1487919932
Name:OLIVERA-RODRIGUEZ, LUIS JAVIER (MD, MPH)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:JAVIER
Last Name:OLIVERA-RODRIGUEZ
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 VINELAND RD STE 109
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7829
Mailing Address - Country:US
Mailing Address - Phone:407-930-6684
Mailing Address - Fax:949-404-8433
Practice Address - Street 1:6001 VINELAND RD STE 109
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7829
Practice Address - Country:US
Practice Address - Phone:407-930-6684
Practice Address - Fax:949-404-8433
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2022-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR193422084P0800X
FLME1293002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018302900Medicaid