Provider Demographics
NPI:1659304350
Name:OLIVA, DAMASO A JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DAMASO
Middle Name:A
Last Name:OLIVA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:343 W HOUSTON ST
Mailing Address - Street 2:STE 301
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-2385
Mailing Address - Country:US
Mailing Address - Phone:210-225-3764
Mailing Address - Fax:210-226-7153
Practice Address - Street 1:343 W HOUSTON ST
Practice Address - Street 2:STE 301
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-2385
Practice Address - Country:US
Practice Address - Phone:210-225-3764
Practice Address - Fax:210-226-7153
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXKO9682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX043814502Medicaid
TXG27992Medicare UPIN
TX043814502Medicaid