Provider Demographics
NPI:1104442433
Name:OLIVA, ANA MARIA
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:MARIA
Last Name:OLIVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 PINE TREE LN
Mailing Address - Street 2:
Mailing Address - City:LAKE CLARKE SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33406-7841
Mailing Address - Country:US
Mailing Address - Phone:561-310-8277
Mailing Address - Fax:
Practice Address - Street 1:8101 PINE TREE LN
Practice Address - Street 2:
Practice Address - City:LAKE CLARKE SHORES
Practice Address - State:FL
Practice Address - Zip Code:33406-7841
Practice Address - Country:US
Practice Address - Phone:561-310-8277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-124954106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician