Provider Demographics
NPI:1326879008
Name:OLIVERAS GONZALEZ, NICOLE MARIE (MS SLP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:OLIVERAS GONZALEZ
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:REPARTO TERESITA AG9 CALLE27
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-515-8839
Mailing Address - Fax:
Practice Address - Street 1:ALTURAS DE FLAMBOYAN #500, AV. TTE. NELSON MARTINEZ
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-501-4427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4598235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist