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NPI Code Detail

MEDICARE: MISS MAYRA SOFIA OLIVARES MS, RDN, LD

MEDICARE: MISS MAYRA SOFIA OLIVARES MS, RDN, LD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered DietitianDT88674TX

General Provider Information

NPI Number : 1437926193
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS MAYRA SOFIA OLIVARES MS, RDN, LD
Provider Business Mailing Address
First Line : 401 S. 10TH ST. BOX 4605
Second Line :
City : HIDALGO
State : TX
Zip : 78557
Country : US
Telephone Number : 956-340-9290
Fax Number :
Provider Business Practice Location Address
First Line : 1001 RONE DR STE 2
Second Line :
City : WESLACO
State : TX
Zip : 78596-5043
Country : US
Telephone Number : 956-600-3475
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2023
Last Update Date : 01/24/2024

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