Provider Demographics
NPI:1154403608
Name:OLAZABAL, ANGELITA C (DMD)
Entity type:Individual
Prefix:DR
First Name:ANGELITA
Middle Name:C
Last Name:OLAZABAL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 CARR 2
Mailing Address - Street 2:STE 207
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2047
Mailing Address - Country:US
Mailing Address - Phone:787-793-5724
Mailing Address - Fax:
Practice Address - Street 1:PLAZA SUCHVILLE
Practice Address - Street 2:SUITE 207
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966
Practice Address - Country:US
Practice Address - Phone:787-782-0590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2016-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19401223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics