| J Olivieri Professional Health Network Llc | |
|
4512 Ralph Ln Dallas TX 75227-1845 | |
| (214) 381-1910 | |
| (214) 381-2868 |
| Full Name | J Olivieri Professional Health Network Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4512 Ralph Ln, Dallas, Texas |
| Authorized Official Name and Position | Julio Cesar Olivieri (PRESIDENT) |
| Authorized Official Contact | 2143811910 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| J Olivieri Professional Health Network Llc 4512 Ralph Ln Dallas TX 75227-1845 Ph: (214) 381-1910 | J Olivieri Professional Health Network Llc 4512 Ralph Ln Dallas TX 75227-1845 Ph: (214) 381-1910 |
| NPI Number | 1821386905 |
|---|---|
| Provider Enumeration Date | 07/11/2011 |
| Last Update Date | 03/24/2014 |
| Medicare PECOS PAC ID | 3375717879 |
|---|---|
| Medicare Enrollment ID | O20111118000379 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821386905 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Julio C Olivieri |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1881605780 PECOS PAC ID: 4587667555 Enrollment ID: I20060811000089 |
| Provider Name | Amanda D Madison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548661556 PECOS PAC ID: 2062634298 Enrollment ID: I20141104000338 |
| Provider Name | Kashaelyn Lanieca Hollins Henderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912493230 PECOS PAC ID: 9931446440 Enrollment ID: I20190122002769 |
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