Provider Demographics
NPI:1821737743
Name:OLIVAREZ, ZACARIAS
Entity Type:Individual
Prefix:
First Name:ZACARIAS
Middle Name:
Last Name:OLIVAREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 E EXPRESSWAY 83 STE A6
Mailing Address - Street 2:
Mailing Address - City:DONNA
Mailing Address - State:TX
Mailing Address - Zip Code:78537-2742
Mailing Address - Country:US
Mailing Address - Phone:956-212-4592
Mailing Address - Fax:
Practice Address - Street 1:702 E EXPRESSWAY 83 STE A6
Practice Address - Street 2:
Practice Address - City:DONNA
Practice Address - State:TX
Practice Address - Zip Code:78537-2742
Practice Address - Country:US
Practice Address - Phone:956-420-1802
Practice Address - Fax:956-420-1804
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119556235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist