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NPI Code Detail

MEDICARE: JAMES OLIVER RD

MEDICARE: JAMES OLIVER RD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian86065420TX

General Provider Information

NPI Number : 1285395053
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES OLIVER RD
Provider Business Mailing Address
First Line : 400 W BITTERS RD APT 608
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78216-7940
Country : US
Telephone Number : 210-286-6532
Fax Number :
Provider Business Practice Location Address
First Line : 1870 W BITTERS RD STE 101
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78248-1827
Country : US
Telephone Number : 210-545-4422
Fax Number : 888-582-7143
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2022
Last Update Date : 09/22/2023

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