Provider Demographics
NPI:1235791211
Name:OLIVEROS, JACQUELINE MARIE SANTIAGO (BCABA)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MARIE SANTIAGO
Last Name:OLIVEROS
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 DOVER CT
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-2503
Mailing Address - Country:US
Mailing Address - Phone:407-493-8766
Mailing Address - Fax:
Practice Address - Street 1:5257 BONAIRRE BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-5363
Practice Address - Country:US
Practice Address - Phone:407-493-8766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-01
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst