Provider Demographics
NPI:1588116164
Name:OLIVA RODRIGUEZ, ADRIAN OCTAVIO (SA-C)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:OCTAVIO
Last Name:OLIVA RODRIGUEZ
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3940 SAN LUIS DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34235-3545
Mailing Address - Country:US
Mailing Address - Phone:941-323-1279
Mailing Address - Fax:
Practice Address - Street 1:3940 SAN LUIS DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34235-3545
Practice Address - Country:US
Practice Address - Phone:941-323-1279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-28
Last Update Date:2019-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16-659246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant