Provider Demographics
NPI:1588952311
Name:OLACIO, MARIZELI AMALIA (DPM)
Entity type:Individual
Prefix:
First Name:MARIZELI
Middle Name:AMALIA
Last Name:OLACIO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 NE MIAMI GARDENS DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4845
Mailing Address - Country:US
Mailing Address - Phone:305-514-0404
Mailing Address - Fax:305-504-8944
Practice Address - Street 1:1400 NE MIAMI GARDENS DR
Practice Address - Street 2:SUITE 104
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-4845
Practice Address - Country:US
Practice Address - Phone:305-514-0404
Practice Address - Fax:305-504-8944
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3502213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist