Provider Demographics
NPI:1093728784
Name:OLIVA, ALFONSO (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFONSO
Middle Name:
Last Name:OLIVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 S COWLEY ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1316
Mailing Address - Country:US
Mailing Address - Phone:509-838-1010
Mailing Address - Fax:509-777-1070
Practice Address - Street 1:530 S COWLEY ST STE 140
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1316
Practice Address - Country:US
Practice Address - Phone:509-838-1010
Practice Address - Fax:509-777-1070
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA91-1722209208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery