Provider Demographics
NPI:1841338381
Name:OLVERA, VICTOR (LMP)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:OLVERA
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2912
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-2912
Mailing Address - Country:US
Mailing Address - Phone:360-698-1142
Mailing Address - Fax:
Practice Address - Street 1:19623 VIKING AVE NW STE 100
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-8374
Practice Address - Country:US
Practice Address - Phone:360-271-1374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA9028225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist