Healthcare Provider Details

I. General information

NPI: 1689649436
Provider Name (Legal Business Name): OLIVERIO CORCHADO P.A.-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19780 S US HIGHWAY 281
SAN ANTONIO TX
78221-9761
US

IV. Provider business mailing address

PO BOX 87
SAN ANTONIO TX
78291-0087
US

V. Phone/Fax

Practice location:
  • Phone: 210-626-0600
  • Fax: 210-626-1174
Mailing address:
  • Phone: 210-626-0600
  • Fax: 210-626-1174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA03720
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: