Healthcare Provider Details

I. General information

NPI: 1386629038
Provider Name (Legal Business Name): ANTONIO OLIVERA MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10213 ROSECRANS AVE
BELLFLOWER CA
90706-2601
US

IV. Provider business mailing address

10213 ROSECRANS AVE
BELLFLOWER CA
90706-2601
US

V. Phone/Fax

Practice location:
  • Phone: 562-461-0600
  • Fax: 562-461-0116
Mailing address:
  • Phone: 562-461-0600
  • Fax: 562-461-0116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: