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General NPI Number Information
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NPI Number | 1669101119
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Entity Type | Individual
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Provider Name | ROBERT OLIVER PA
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Gender | Male
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Dates
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Enumeration Date | 06/09/2022
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 191 E ALESSANDRO BLVD
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City | RIVERSIDE
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State | CA
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Zip | 92508-5095
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Country | US
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Telephone | 951-780-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 5132 SPARROW DR
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92649-1400
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Country | US
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Telephone | 714-470-1771
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA61071
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License Number State | CA
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