Healthcare Provider Details

I. General information

NPI: 1851066278
Provider Name (Legal Business Name): RICARDO ANTONIO ARCEO OLAIZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2021
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5730 GLENRIDGE DR STE 200
ATLANTA GA
30328-5579
US

IV. Provider business mailing address

4499 MEDICAL DR STE 360
SAN ANTONIO TX
78229-3857
US

V. Phone/Fax

Practice location:
  • Phone: 404-252-5206
  • Fax:
Mailing address:
  • Phone: 210-615-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberU6191
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: