Provider Demographics
NPI:1548572282
Name:OLIVA, MARK ANTHONY CABUAG (RPT)
Entity Type:Individual
Prefix:MR
First Name:MARK ANTHONY
Middle Name:CABUAG
Last Name:OLIVA
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 GOLF CT
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-3412
Mailing Address - Country:US
Mailing Address - Phone:650-961-2386
Mailing Address - Fax:
Practice Address - Street 1:1031 GOLF CT
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-3412
Practice Address - Country:US
Practice Address - Phone:650-961-2386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24492225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist