Healthcare Provider Details

I. General information

NPI: 1184292005
Provider Name (Legal Business Name): ERIC OLIVAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 W SOUTHERN AVE BLDG B10
APACHE JUNCTION AZ
85120-7653
US

IV. Provider business mailing address

2080 W SOUTHERN AVE BLDG B10
APACHE JUNCTION AZ
85120-7653
US

V. Phone/Fax

Practice location:
  • Phone: 480-893-7685
  • Fax:
Mailing address:
  • Phone: 602-887-3661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-84006
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: