MEDICARE: DR. DAMASO A OLIVA JR. M.D.

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
1	2084P0800X	Psychiatry Physician	KO968	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659304350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAMASO A OLIVA JR. M.D.

Provider Business Mailing Address
First Line	:	343 W HOUSTON ST
Second Line	:	STE 301
City	:	SAN ANTONIO
State	:	TX
Zip	:	78205-2385
Country	:	US
Telephone Number	:	210-225-3764
Fax Number	:	210-226-7153

Provider Business Practice Location Address
First Line	:	343 W HOUSTON ST
Second Line	:	STE 301
City	:	SAN ANTONIO
State	:	TX
Zip	:	78205-2385
Country	:	US
Telephone Number	:	210-225-3764
Fax Number	:	210-226-7153

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	02/27/2012

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