Provider Demographics
NPI:1497997571
Name:OLIVARES, GUSTAVO F (PA)
Entity Type:Individual
Prefix:MR
First Name:GUSTAVO
Middle Name:F
Last Name:OLIVARES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6900 N 10TH ST STE 8
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-3151
Mailing Address - Country:US
Mailing Address - Phone:956-994-8707
Mailing Address - Fax:956-994-1696
Practice Address - Street 1:6900 N 10TH ST STE 8
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3151
Practice Address - Country:US
Practice Address - Phone:956-994-8707
Practice Address - Fax:956-994-1696
Is Sole Proprietor?:No
Enumeration Date:2009-04-03
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04553363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant