Individual
MR. WILBERTO OLIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4215 EDGEWATER DR, ORLANDO, FL 32804-2206
(973) 826-8291
Mailing address
PO BOX 4059, WAYNE, NJ 07474-4059
(973) 826-8291
(888) 972-6480
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA9102488
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
291620700
—
FL
01
—
PA9102488
LICENSE
FL
Enumeration date
11/08/2006
Last updated
03/12/2021
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