Healthcare Provider Details

I. General information

NPI: 1144649153
Provider Name (Legal Business Name): OLIVIA A FUNES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLIVIA A VILLANUEVA PA-C

II. Dates (important events)

Enumeration Date: 04/08/2014
Last Update Date: 05/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4499 MEDICAL DR SUITE 151A
SAN ANTONIO TX
78229-3735
US

IV. Provider business mailing address

4499 MEDICAL DR SUITE 151A
SAN ANTONIO TX
78229-3735
US

V. Phone/Fax

Practice location:
  • Phone: 210-593-4392
  • Fax: 210-593-0152
Mailing address:
  • Phone: 210-593-4392
  • Fax: 210-593-0152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA09093
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: