Provider Demographics
NPI:1497635544
Name:OLIVARES, EDERARDO
Entity type:Individual
Prefix:
First Name:EDERARDO
Middle Name:
Last Name:OLIVARES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7379 SW 22ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1426
Mailing Address - Country:US
Mailing Address - Phone:786-315-0208
Mailing Address - Fax:
Practice Address - Street 1:7379 SW 22ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1426
Practice Address - Country:US
Practice Address - Phone:786-315-0208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-469983106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician