Provider Demographics
NPI:1891882239
Name:OLIVA, CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:OLIVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 S SANTA FE AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-7010
Mailing Address - Country:US
Mailing Address - Phone:760-941-7050
Mailing Address - Fax:760-941-7142
Practice Address - Street 1:1070 S SANTA FE AVE STE 9
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-7010
Practice Address - Country:US
Practice Address - Phone:760-941-7050
Practice Address - Fax:760-941-7142
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40155207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA40155Medicare ID - Type UnspecifiedAND MEDICAL
CAA85393Medicare UPIN