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General NPI Number Information
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NPI Number | 1518076256
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Entity Type | Organization
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Legal Business Name | OLIVEIRA MEDICAL INC
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 506 W GRAHAM AVE STE 107
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City | LAKE ELSINORE
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State | CA
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Zip | 92530
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Country | US
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Telephone | 951-471-5116
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Fax | 951-471-5226
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Provider Business Mailing Address
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Address Line | 506 W GRAHAM AVE STE 107
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City | LAKE ELSINORE
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State | CA
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Zip | 92530
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Country | US
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Telephone | 951-471-5116
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Fax | 951-471-5226
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS EDWARD OLIVEIRA
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Credential | D.O.
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Telephone | 951-471-5116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 20A7032
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License Number State | CA
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