Healthcare Provider Details

I. General information

NPI: 1528079399
Provider Name (Legal Business Name): RENE L OLVERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 06/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7703 FLOYD CURL DR MC 7977
SAN ANTONIO TX
78229-3901
US

IV. Provider business mailing address

7703 FLOYD CURL DR MC 7977
SAN ANTONIO TX
78229-3901
US

V. Phone/Fax

Practice location:
  • Phone: 210-257-1400
  • Fax: 210-257-1428
Mailing address:
  • Phone: 210-257-1400
  • Fax: 210-257-1428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberJ0171
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: