Provider Demographics
NPI:1124429733
Name:OLIVIERI URBAN CLINIC LLC
Entity type:Organization
Organization Name:OLIVIERI URBAN CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:C
Authorized Official - Last Name:OLIVIERI
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:214-381-1910
Mailing Address - Street 1:6300 SAMUELL BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-7137
Mailing Address - Country:US
Mailing Address - Phone:214-381-1910
Mailing Address - Fax:214-381-2868
Practice Address - Street 1:4512 RALPH LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-1845
Practice Address - Country:US
Practice Address - Phone:214-381-1910
Practice Address - Fax:214-381-2868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-15
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty