Healthcare Provider Details

I. General information

NPI: 1326356692
Provider Name (Legal Business Name): JULIO OLMEDA APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 09/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 PEASE ST STE 1 J
HARLINGEN TX
78550-8348
US

IV. Provider business mailing address

5010 FIRESTONE DR
HARLINGEN TX
78552-6222
US

V. Phone/Fax

Practice location:
  • Phone: 956-389-4060
  • Fax: 956-389-3567
Mailing address:
  • Phone: 956-491-2848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number630245
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: