Provider Demographics
NPI:1417971938
Name:OLIVARES, REBECCA A (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:A
Last Name:OLIVARES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:426 CASTROVILLE RD
Mailing Address - Street 2:STE 1
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-5169
Mailing Address - Country:US
Mailing Address - Phone:210-922-2270
Mailing Address - Fax:210-922-2292
Practice Address - Street 1:426 CASTROVILLE RD
Practice Address - Street 2:STE 1
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-5169
Practice Address - Country:US
Practice Address - Phone:210-922-2270
Practice Address - Fax:210-922-2292
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2018-08-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXG5446207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133461706Medicaid
TX133461702Medicaid
TXEO3438Medicare UPIN
TX133461706Medicaid