Healthcare Provider Details

I. General information

NPI: 1386033926
Provider Name (Legal Business Name): JOSE OLIVERIA III DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2015
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SHIELDS AVE
DAVIS CA
95616-5270
US

IV. Provider business mailing address

1 SHIELDS AVE
DAVIS CA
95616-5270
US

V. Phone/Fax

Practice location:
  • Phone: 415-469-8374
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95011753
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: