Provider Demographics
NPI:1538345319
Name:OLAVARRIA, GLORIA ESTHER (OB-GYN MD)
Entity type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:ESTHER
Last Name:OLAVARRIA
Suffix:
Gender:F
Credentials:OB-GYN MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 9368 COTTO STATION
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-9368
Mailing Address - Country:US
Mailing Address - Phone:787-878-6776
Mailing Address - Fax:787-816-8163
Practice Address - Street 1:ARECIBO MEDICAL PLAZA
Practice Address - Street 2:108 SUITE
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-880-0009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6962174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR84496Medicaid