Provider Demographics
NPI:1396877171
Name:OLIVER, ANTHONY MORRIS SR (LPT)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:MORRIS
Last Name:OLIVER
Suffix:SR
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1849 N HOLLYWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-1515
Mailing Address - Country:US
Mailing Address - Phone:213-447-5356
Mailing Address - Fax:
Practice Address - Street 1:1720 E 120TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059-3052
Practice Address - Country:US
Practice Address - Phone:310-668-5150
Practice Address - Fax:310-223-0695
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPT30396167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician