Provider Demographics
NPI:1104905041
Name:OLIVAS, ELIZABETH (LMT)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:OLIVAS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1281 NW 48TH PL
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-1020
Mailing Address - Country:US
Mailing Address - Phone:954-422-1921
Mailing Address - Fax:
Practice Address - Street 1:199 W PALMETTO PARK RD
Practice Address - Street 2:SUITE 6
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-3809
Practice Address - Country:US
Practice Address - Phone:561-392-3340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0007392174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65-0344948OtherTAX ID NUMBER