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General NPI Number Information
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NPI Number | 1386509321
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Entity Type | Individual
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Provider Name | MATTHEW B OLAITAN
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Gender | Male
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Dates
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Enumeration Date | 12/22/2025
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 12463 CHAZELLE
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City | SAN ANTONIO
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State | TX
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Zip | 78254-4856
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Country | US
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Telephone | 401-450-8218
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Fax | 401-450-8218
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Provider Business Mailing Address
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Address Line | 12463 CHAZELLE
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City | SAN ANTONIO
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State | TX
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Zip | 78254-4856
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Country | US
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Telephone | 401-450-8218
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Fax | 401-450-8218
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | 1071964
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1071964
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License Number State | TX
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