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General NPI Number Information
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NPI Number | 1942409198
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Entity Type | Organization
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Legal Business Name | PROVIDENCE MEDICAL AND GERIATRIC ASSOCIATES, PA
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Dates
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Enumeration Date | 07/17/2007
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Last Update Date | 01/20/2020
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Provider Practice Location Address
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Address Line | 110 E SAVANNAH AVE BLDG C SUITE 103
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City | MCALLEN
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State | TX
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Zip | 78503-1241
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Country | US
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Telephone | 956-971-8800
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Fax | 956-971-8804
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Provider Business Mailing Address
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Address Line | PO BOX 306
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City | MCALLEN
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State | TX
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Zip | 78505-0306
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Country | US
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Telephone | 956-971-8800
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Fax | 956-971-8804
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. OLGA MARIA OLIVARES-HERRERA
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Credential | MD
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Telephone | 956-971-8800
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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 | M2431
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License Number State | TX
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