Healthcare Provider Details

I. General information

NPI: 1093728784
Provider Name (Legal Business Name): ALFONSO OLIVA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 06/18/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 S COWLEY ST STE 140
SPOKANE WA
99202-1316
US

IV. Provider business mailing address

530 S COWLEY ST
SPOKANE WA
99202-1316
US

V. Phone/Fax

Practice location:
  • Phone: 509-838-1010
  • Fax: 509-777-1070
Mailing address:
  • Phone: 509-838-1010
  • Fax: 509-777-1070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number91-1722209
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: