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NPI Code Detail

MEDICARE: DR. JUAN OLIVARES JR. MD

MEDICARE: DR. JUAN OLIVARES JR. MD
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
1208000000XPediatrics PhysicianN9617TX

General Provider Information

NPI Number : 1730474735
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JUAN OLIVARES JR. MD
Provider Business Mailing Address
First Line : 3660 RICHMOND AVE APT 359
Second Line :
City : HOUSTON
State : TX
Zip : 77046-3604
Country : US
Telephone Number : 214-280-9919
Fax Number :
Provider Business Practice Location Address
First Line : 5808 AIRLINE DR
Second Line :
City : HOUSTON
State : TX
Zip : 77076-4923
Country : US
Telephone Number : 713-695-4013
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2011
Last Update Date : 03/12/2012

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