Provider Demographics
NPI:1396222170
Name:OLIVARES, ORLANDO
Entity Type:Individual
Prefix:
First Name:ORLANDO
Middle Name:
Last Name:OLIVARES
Suffix:
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 1:12233 DELACROIX DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-0231
Mailing Address - Country:US
Mailing Address - Phone:915-346-7334
Mailing Address - Fax:
Practice Address - Street 1:12233 DELACROIX DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-0231
Practice Address - Country:US
Practice Address - Phone:915-346-7334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX621216163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse