Healthcare Provider Details

I. General information

NPI: 1104023662
Provider Name (Legal Business Name): DANIEL WAYNE OLIVIERI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

964 CHORRO ST SUITE 2
SAN LUIS OBISPO CA
93401-3202
US

IV. Provider business mailing address

964 CHORRO ST SUITE 2
SAN LUIS OBISPO CA
93401-3202
US

V. Phone/Fax

Practice location:
  • Phone: 805-543-3232
  • Fax: 805-547-1772
Mailing address:
  • Phone: 805-543-3232
  • Fax: 805-547-1772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberC 50223
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: