Provider Demographics
NPI:1912910464
Name:VALDEZ, OLIVIA A (MD)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:A
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 HILL COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-2906
Mailing Address - Country:US
Mailing Address - Phone:210-545-3480
Mailing Address - Fax:210-545-1839
Practice Address - Street 1:202 HILL COUNTRY LN
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-2906
Practice Address - Country:US
Practice Address - Phone:210-545-3480
Practice Address - Fax:210-545-1839
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG79222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8308M0OtherBLUE CROSS BLUE SHIELD
TX139518803Medicaid
TX139518803Medicaid
TX8308M0OtherBLUE CROSS BLUE SHIELD