Healthcare Provider Details

I. General information

NPI: 1013400522
Provider Name (Legal Business Name): MR. ADRIAN MARIO OLVERA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2018
Last Update Date: 06/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47940 ARABIA ST
INDIO CA
92201-6828
US

IV. Provider business mailing address

47940 ARABIA ST
INDIO CA
92201-6828
US

V. Phone/Fax

Practice location:
  • Phone: 760-909-0544
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: