Provider Demographics
NPI:1629578513
Name:OLVERA, ERICA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:OLVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11415 LAYBACK CRK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-9207
Mailing Address - Country:US
Mailing Address - Phone:210-995-1162
Mailing Address - Fax:
Practice Address - Street 1:11415 LAYBACK CRK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-9207
Practice Address - Country:US
Practice Address - Phone:210-995-1162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX331984164X00000X
TX1034878163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No164X00000XNursing Service ProvidersLicensed Vocational Nurse