Provider Demographics
NPI:1972671618
Name:OLIVERA, TODD PATRICK (ATC)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:PATRICK
Last Name:OLIVERA
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 NIBLICK RD
Mailing Address - Street 2:PMB 179
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-4845
Mailing Address - Country:US
Mailing Address - Phone:805-239-2304
Mailing Address - Fax:
Practice Address - Street 1:179 NIBLICK RD
Practice Address - Street 2:PMB 179
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-4845
Practice Address - Country:US
Practice Address - Phone:805-239-2304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program