Healthcare Provider Details

I. General information

NPI: 1124907332
Provider Name (Legal Business Name): JOSE BELIZARIO OLIVAS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2025
Last Update Date: 09/01/2025
Certification Date: 08/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10898 BOESSOW RD
GALT CA
95632-8451
US

IV. Provider business mailing address

3131 INDEPENDENCE DR
LIVERMORE CA
94551-7595
US

V. Phone/Fax

Practice location:
  • Phone: 925-334-7186
  • Fax:
Mailing address:
  • Phone: 925-388-8059
  • Fax: 925-336-3277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number13785
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: