Provider Demographics
NPI:1821420308
Name:OLIVAREZ, MELANIE ANN (PA)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:ANN
Last Name:OLIVAREZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:ANN
Other - Last Name:SALDIVAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2961 MOSSROCK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5119
Mailing Address - Country:US
Mailing Address - Phone:210-731-4800
Mailing Address - Fax:210-731-4810
Practice Address - Street 1:615 NW LOOP 410 STE 210
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-5520
Practice Address - Country:US
Practice Address - Phone:210-384-8282
Practice Address - Fax:210-384-8629
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08379363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant