Provider Demographics
NPI:1912725573
Name:OLIVAS PALMA, SALOMON SR
Entity type:Individual
Prefix:MR
First Name:SALOMON
Middle Name:
Last Name:OLIVAS PALMA
Suffix:SR
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 1:217 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-3811
Mailing Address - Country:US
Mailing Address - Phone:239-231-0401
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:4019 SANTA BARBARA BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-8808
Practice Address - Country:US
Practice Address - Phone:239-231-0401
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-01
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA99509225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist