Provider Demographics
NPI:1972002285
Name:NEVAREZ, OLIVIA
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:NEVAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2752
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-2752
Mailing Address - Country:US
Mailing Address - Phone:505-429-7372
Mailing Address - Fax:
Practice Address - Street 1:13 VISION DRIVE
Practice Address - Street 2:
Practice Address - City:RIBERA
Practice Address - State:NM
Practice Address - Zip Code:87560-8756
Practice Address - Country:US
Practice Address - Phone:505-429-7372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician