Healthcare Provider Details

I. General information

NPI: 1033169818
Provider Name (Legal Business Name): BERNARDO OLAYA M.D. P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 MIDWESTERN PKWY
WICHITA FALLS TX
76308-2300
US

IV. Provider business mailing address

PO BOX 4106
WICHITA FALLS TX
76308-0106
US

V. Phone/Fax

Practice location:
  • Phone: 940-766-6500
  • Fax: 940-766-6506
Mailing address:
  • Phone: 940-766-6500
  • Fax: 940-766-6506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberG8740
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG8740
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: