Provider Demographics
NPI:1487934733
Name:OLIVERA, NOEL R (ARDMS,CCI)
Entity type:Individual
Prefix:
First Name:NOEL
Middle Name:R
Last Name:OLIVERA
Suffix:
Gender:M
Credentials:ARDMS,CCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19850 NW 78TH PATH
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-6631
Mailing Address - Country:US
Mailing Address - Phone:786-223-5153
Mailing Address - Fax:305-918-4028
Practice Address - Street 1:19850 NW 78TH PATH
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-6631
Practice Address - Country:US
Practice Address - Phone:786-223-5153
Practice Address - Fax:305-918-4028
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00026021246XS1301X, 2471V0105X
FL563902471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
No246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography