Provider Demographics
NPI:1659905859
Name:OLIVARES, ANDREA MONIQUE
Entity Type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:MONIQUE
Last Name:OLIVARES
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 1:7880 FREDERICKSBURG RD # 2107
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3418
Mailing Address - Country:US
Mailing Address - Phone:210-850-6856
Mailing Address - Fax:
Practice Address - Street 1:7880 FREDERICKSBURG RD # 2107
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3418
Practice Address - Country:US
Practice Address - Phone:210-850-6856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider