Provider Demographics
NPI:1962264804
Name:MENENDEZ OLITE, LUIS ALBERTO
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:ALBERTO
Last Name:MENENDEZ OLITE
Suffix:
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 1:2119 SW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-1813
Mailing Address - Country:US
Mailing Address - Phone:786-273-8145
Mailing Address - Fax:
Practice Address - Street 1:2119 SW 4TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1813
Practice Address - Country:US
Practice Address - Phone:786-273-8145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-185799247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Multi-Specialty