Provider Demographics
NPI:1083191746
Name:OLIVAREZ JR, JUAN G (RN)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:G
Last Name:OLIVAREZ JR
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 E CANADIAN DR
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-7794
Mailing Address - Country:US
Mailing Address - Phone:956-821-8195
Mailing Address - Fax:
Practice Address - Street 1:1207 E CANADIAN DR
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-7794
Practice Address - Country:US
Practice Address - Phone:956-821-8195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX847337163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1790847531Medicaid