Provider Demographics
NPI:1982875167
Name:LLAMAS, OLEGARIO
Entity Type:Individual
Prefix:
First Name:OLEGARIO
Middle Name:
Last Name:LLAMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 ASH ST
Mailing Address - Street 2:
Mailing Address - City:MORENCI
Mailing Address - State:AZ
Mailing Address - Zip Code:85540-9640
Mailing Address - Country:US
Mailing Address - Phone:928-865-4844
Mailing Address - Fax:
Practice Address - Street 1:133 ASH ST
Practice Address - Street 2:
Practice Address - City:MORENCI
Practice Address - State:AZ
Practice Address - Zip Code:85540-9640
Practice Address - Country:US
Practice Address - Phone:928-865-4844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child