Provider Demographics
NPI:1306823505
Name:OLIVER, AIMEE AQUINO (DO)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:AQUINO
Last Name:OLIVER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2520 BROADWAY ST
Mailing Address - Street 2:STE #100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-1140
Mailing Address - Country:US
Mailing Address - Phone:210-595-1019
Mailing Address - Fax:210-251-3194
Practice Address - Street 1:2520 BROADWAY ST
Practice Address - Street 2:STE #100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215
Practice Address - Country:US
Practice Address - Phone:210-595-1019
Practice Address - Fax:210-251-3194
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101015834207Q00000X
TXN9164207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MII30885Medicare UPIN