Provider Demographics
NPI:1770902611
Name:OLIVAS, EDGAR (MD)
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:
Last Name:OLIVAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 W HUNTINGTON DR DEPT OF
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-3402
Mailing Address - Country:US
Mailing Address - Phone:626-898-8795
Mailing Address - Fax:626-821-6955
Practice Address - Street 1:713 W DUARTE RD
Practice Address - Street 2:# G316
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7564
Practice Address - Country:US
Practice Address - Phone:626-566-2866
Practice Address - Fax:626-566-2850
Is Sole Proprietor?:No
Enumeration Date:2014-04-08
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA1412252084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology