MEDICARE: MR. RICHARD A OLIVA M.D.

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	208D00000X	General Practice Physician	A109221	CA
2	2084P0800X	Psychiatry Physician	A109221	CA

General Provider Information

NPI Number	:	1952599938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD A OLIVA M.D.

Provider Business Mailing Address
First Line	:	1408 CALIFORNIA ST APT 405
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-4726
Country	:	US
Telephone Number	:	760-473-1812
Fax Number	:

Provider Business Practice Location Address
First Line	:	969 S SANTA FE AVE STE A
Second Line	:
City	:	VISTA
State	:	CA
Zip	:	92083-6910
Country	:	US
Telephone Number	:	760-941-7050
Fax Number	:	760-941-7142

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

Provider Enumeration Date	:	10/04/2007
Last Update Date	:	01/22/2020

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