Provider Demographics
NPI:1952599938
Name:OLIVA, RICHARD A (MD)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:A
Last Name:OLIVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1408 CALIFORNIA ST APT 405
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-4726
Mailing Address - Country:US
Mailing Address - Phone:760-473-1812
Mailing Address - Fax:
Practice Address - Street 1:969 S SANTA FE AVE STE A
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6910
Practice Address - Country:US
Practice Address - Phone:760-941-7050
Practice Address - Fax:760-941-7142
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA109221208D00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice