Provider Demographics
NPI:1982915971
Name:OLACIO, RAFAEL JR (PA-C)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:OLACIO
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 VICTORIA LN
Mailing Address - Street 2:SUITE 12
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-3226
Mailing Address - Country:US
Mailing Address - Phone:956-440-6300
Mailing Address - Fax:
Practice Address - Street 1:512 VICTORIA LN
Practice Address - Street 2:SUITE 12
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-3226
Practice Address - Country:US
Practice Address - Phone:956-440-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06825363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical