MEDICARE: MISS TARA OLIVERI PA-C

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
1	363A00000X	Physician Assistant	PA20936	CA
2	363AM0700X	Medical Physician Assistant	25MP00208500	NJ

General Provider Information

NPI Number	:	1467606913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS TARA OLIVERI PA-C

Provider Business Mailing Address
First Line	:	5162 VIA VALARTA
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92124-1564
Country	:	US
Telephone Number	:	570-977-5463
Fax Number	:

Provider Business Practice Location Address
First Line	:	28078 BAXTER RD STE 530
Second Line	:
City	:	MURRIETA
State	:	CA
Zip	:	92563-1405
Country	:	US
Telephone Number	:	951-566-5229
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2008
Last Update Date	:	12/13/2019

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Directions to “ MISS TARA OLIVERI PA-C” Practice Location

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