Provider Demographics
NPI:1316601552
Name:OLIVAREZ, ANGELES
Entity Type:Individual
Prefix:
First Name:ANGELES
Middle Name:
Last Name:OLIVAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3071 S BRAND LEE WAY
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-5109
Mailing Address - Country:US
Mailing Address - Phone:602-832-4462
Mailing Address - Fax:
Practice Address - Street 1:815 E. CESAR CHAVEZ BLVD
Practice Address - Street 2:
Practice Address - City:SAN LUIS
Practice Address - State:AZ
Practice Address - Zip Code:85349
Practice Address - Country:US
Practice Address - Phone:928-627-3822
Practice Address - Fax:928-627-3989
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ147479Medicaid