Provider Demographics
NPI:1932753019
Name:OLIVAR MATA, MARIA JOSEFINA (SA-C)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:JOSEFINA
Last Name:OLIVAR MATA
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5271 SUNNY BEACH LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-1391
Mailing Address - Country:US
Mailing Address - Phone:832-727-2423
Mailing Address - Fax:
Practice Address - Street 1:5271 SUNNY BEACH LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1391
Practice Address - Country:US
Practice Address - Phone:832-727-2423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-28
Last Update Date:2019-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV19-322246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant