Healthcare Provider Details

I. General information

NPI: 1760626675
Provider Name (Legal Business Name): ALCIDES ANTONIO DE OLIVEIRA NURSE PRACTITIONER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 S GLASSELL ST
ORANGE CA
92866-1945
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 714-997-2899
  • Fax: 714-639-3708
Mailing address:
  • Phone: 702-579-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17935
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: