MEDICARE: EDGAR OLIVAS MD

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	2084N0400X	Neurology Physician	A141225	CA

General Provider Information

NPI Number	:	1770902611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDGAR OLIVAS MD

Provider Business Mailing Address
First Line	:	300 W HUNTINGTON DR DEPT OF
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91007-3402
Country	:	US
Telephone Number	:	626-898-8795
Fax Number	:	626-821-6955

Provider Business Practice Location Address
First Line	:	713 W DUARTE RD
Second Line	:	# G316
City	:	ARCADIA
State	:	CA
Zip	:	91007-7564
Country	:	US
Telephone Number	:	626-566-2866
Fax Number	:	626-566-2850

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

Provider Enumeration Date	:	04/08/2014
Last Update Date	:	08/17/2021

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