Provider Demographics
NPI:1598933921
Name:PETALVER, OLIVER CARINO (PA-C)
Entity Type:Individual
Prefix:
First Name:OLIVER
Middle Name:CARINO
Last Name:PETALVER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8333 IOWA ST STE 200
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-4994
Mailing Address - Country:US
Mailing Address - Phone:562-923-1211
Mailing Address - Fax:
Practice Address - Street 1:8333 IOWA ST STE 200
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4994
Practice Address - Country:US
Practice Address - Phone:562-923-1211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19544363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical