Provider Demographics
NPI:1871814855
Name:CARLOS T OLIVEIRA LLC
Entity Type:Organization
Organization Name:CARLOS T OLIVEIRA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:T
Authorized Official - Last Name:OLIVEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:956-727-3801
Mailing Address - Street 1:7917 MCPHERSON RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-2811
Mailing Address - Country:US
Mailing Address - Phone:956-727-3801
Mailing Address - Fax:956-727-2357
Practice Address - Street 1:7917 MCPHERSON RD
Practice Address - Street 2:SUITE 207
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-2811
Practice Address - Country:US
Practice Address - Phone:956-727-3801
Practice Address - Fax:956-727-2357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-14
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50238237600000X, 332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332S00000XSuppliersHearing Aid Equipment
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2120115-01Medicaid