Basic Information
| Provider Information | |||||||||
| NPI: | 1801016399 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLIVIERI-BEAUCHAMP | ||||||||
| FirstName: | VILMA | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 29134 EDIF.. PRINCIPAL RCM-UPR | ||||||||
| Address2: | RECINTO DE CIENCIAS MEDICAS (UPR-RCM/RADIOLOGIA) | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009290134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877773535 | ||||||||
| FaxNumber: | 7877773855 | ||||||||
| Practice Location | |||||||||
| Address1: | CARR. 22, BO. MANACILLOS, RCM-RADIOLOGIA | ||||||||
| Address2: | ADMINISTRACION DE SERVICIOS MEDICOS DE P.R. | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009290134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877773535 | ||||||||
| FaxNumber: | 7877773855 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2007 | ||||||||
| LastUpdateDate: | 01/07/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 10373 | PR | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 10373 | 01 | PR | PUERTO RICO | OTHER |