Provider Demographics
NPI:1255819124
Name:OLIVARES, ANGELA T (QMHS)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:T
Last Name:OLIVARES
Suffix:
Gender:F
Credentials:QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6629 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-1098
Mailing Address - Country:US
Mailing Address - Phone:419-475-4449
Mailing Address - Fax:
Practice Address - Street 1:800 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5256
Practice Address - Country:US
Practice Address - Phone:419-352-5387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker