Provider Demographics
NPI:1750685970
Name:OLIVA, MARIA TERESA AQUINO
Entity Type:Individual
Prefix:MRS
First Name:MARIA TERESA
Middle Name:AQUINO
Last Name:OLIVA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARIA TERESA
Other - Middle Name:ICASIANO
Other - Last Name:AQUINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:255-B CONSTITUTION DR.
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025
Mailing Address - Country:US
Mailing Address - Phone:650-691-5653
Mailing Address - Fax:
Practice Address - Street 1:255-B CONSTITUTION DR.
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025
Practice Address - Country:US
Practice Address - Phone:650-691-5653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-03
Last Update Date:2019-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF58281106H00000X
CALMFT 53901106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist