Healthcare Provider Details

I. General information

NPI: 1962334839
Provider Name (Legal Business Name): ALEXANDER OLAVIDES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 SEVEN HILLS DR STE 120
HENDERSON NV
89052-3011
US

IV. Provider business mailing address

7180 CASCADE VALLEY CT STE 200
LAS VEGAS NV
89128-0481
US

V. Phone/Fax

Practice location:
  • Phone: 702-240-8639
  • Fax:
Mailing address:
  • Phone: 702-240-8639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13214-M
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: