Provider Demographics
NPI:1699348375
Name:OLGPA ENTERPRISE LLC
Entity type:Organization
Organization Name:OLGPA ENTERPRISE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-361-9290
Mailing Address - Street 1:PO BOX 950572
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32795-0572
Mailing Address - Country:US
Mailing Address - Phone:863-758-2273
Mailing Address - Fax:305-400-4176
Practice Address - Street 1:6718 LAKE NONA BLVD STE 240
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7985
Practice Address - Country:US
Practice Address - Phone:863-758-2273
Practice Address - Fax:305-400-4176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-21
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty