Provider Demographics
NPI:1023292232
Name:OLIVEIRA, CARLOS T (RPH)
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:T
Last Name:OLIVEIRA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6609 BLANCO ROAD
Mailing Address - Street 2:STE. 115
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6131
Mailing Address - Country:US
Mailing Address - Phone:210-342-2299
Mailing Address - Fax:210-342-5499
Practice Address - Street 1:7917 MCPHERSON RD
Practice Address - Street 2:STE 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
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16484183500000X
TX50238237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0224115-01Medicaid