Provider Demographics
NPI:1033294988
Name:OLAGUE, MANUEL III
Entity Type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:
Last Name:OLAGUE
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2492 S AZTEC POINT TRL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85748-5103
Mailing Address - Country:US
Mailing Address - Phone:520-271-1378
Mailing Address - Fax:
Practice Address - Street 1:2492 S AZTEC POINT TRL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85748-5103
Practice Address - Country:US
Practice Address - Phone:520-271-1378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4772385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child