Provider Demographics
NPI:1184857930
Name:OLIVARES, ANGELINA (SLP)
Entity Type:Individual
Prefix:
First Name:ANGELINA
Middle Name:
Last Name:OLIVARES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ANGELINA
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:701 N WARE RD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-6616
Mailing Address - Country:US
Mailing Address - Phone:956-664-2525
Mailing Address - Fax:956-664-2525
Practice Address - Street 1:701 N WARE RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-6616
Practice Address - Country:US
Practice Address - Phone:956-664-2525
Practice Address - Fax:956-664-2525
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101027235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist