Provider Demographics
NPI:1588008627
Name:OLIVERI, TIA LEA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TIA
Middle Name:LEA
Last Name:OLIVERI
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:7711 LOUIS PASTEUR DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3422
Mailing Address - Country:US
Mailing Address - Phone:210-692-9500
Mailing Address - Fax:210-616-9300
Practice Address - Street 1:7711 LOUIS PASTEUR DR STE 200
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3422
Practice Address - Country:US
Practice Address - Phone:210-692-9500
Practice Address - Fax:210-616-9300
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA09702363AM0700X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical