Provider Demographics
NPI:1548666415
Name:OLIVA, JANET (SFIDC)
Entity type:Individual
Prefix:MS
First Name:JANET
Middle Name:
Last Name:OLIVA
Suffix:
Gender:F
Credentials:SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6305 RIVERDALE RD
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-2105
Mailing Address - Country:US
Mailing Address - Phone:301-919-5635
Mailing Address - Fax:
Practice Address - Street 1:6305 RIVERDALE RD
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-2105
Practice Address - Country:US
Practice Address - Phone:301-919-5635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman