Provider Demographics
NPI:1104018092
Name:OLIVAREZ, JUAN JR
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:
Last Name:OLIVAREZ
Suffix:JR
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 1:1123 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-7023
Mailing Address - Country:US
Mailing Address - Phone:956-544-2421
Mailing Address - Fax:956-544-1136
Practice Address - Street 1:1123 E 12TH ST
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-7023
Practice Address - Country:US
Practice Address - Phone:956-544-2421
Practice Address - Fax:956-544-1136
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies