Provider Demographics
NPI:1992867618
Name:ARVIZU OLVERA, JOSE MANUEL (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:MANUEL
Last Name:ARVIZU OLVERA
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:5141 BROADWAY
Mailing Address - Street 2:NEW YORK PRESBYTERIAN ALLEN HOSPITAL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-1159
Mailing Address - Country:US
Mailing Address - Phone:212-932-4165
Mailing Address - Fax:212-932-5369
Practice Address - Street 1:5141 BROADWAY
Practice Address - Street 2:NEW YORK PRESBYTERIAN ALLEN HOSPITAL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-1159
Practice Address - Country:US
Practice Address - Phone:212-932-4165
Practice Address - Fax:212-932-5369
Is Sole Proprietor?:No
Enumeration Date:2006-12-16
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD125822084P0800X
NY2700522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIMD12582OtherPROFESSIONAL LICENSE