Provider Demographics
NPI:1124219167
Name:OLIVARES, YUDAMAS (NURSING ASSISTANT)
Entity type:Individual
Prefix:
First Name:YUDAMAS
Middle Name:
Last Name:OLIVARES
Suffix:
Gender:F
Credentials:NURSING ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4241 NW 204TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-1316
Mailing Address - Country:US
Mailing Address - Phone:786-439-6264
Mailing Address - Fax:
Practice Address - Street 1:4241 NW 204TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-1316
Practice Address - Country:US
Practice Address - Phone:786-439-6264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372500000XNursing Service Related ProvidersChore Provider