Provider Demographics
NPI:1427023845
Name:OLIVAREZ, GABINO (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:GABINO
Middle Name:
Last Name:OLIVAREZ
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 SKYDALE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-4241
Mailing Address - Country:US
Mailing Address - Phone:915-587-0312
Mailing Address - Fax:
Practice Address - Street 1:100 CHAMPIONS PL
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-3725
Practice Address - Country:US
Practice Address - Phone:915-834-2465
Practice Address - Fax:915-587-6458
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT25872255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer