Healthcare Provider Details

I. General information

NPI: 1851856926
Provider Name (Legal Business Name): NINA Y OLVERA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 OBLATE DR
SAN ANTONIO TX
78216-7332
US

IV. Provider business mailing address

PO BOX 1321
LYTLE TX
78052-1321
US

V. Phone/Fax

Practice location:
  • Phone: 210-656-4363
  • Fax:
Mailing address:
  • Phone: 210-973-2866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA12516
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: