Provider Demographics
NPI:1174798961
Name:OLIVERA, GERARDO
Entity type:Individual
Prefix:MR
First Name:GERARDO
Middle Name:
Last Name:OLIVERA
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 1:341 E. CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:90201-3323
Mailing Address - Country:US
Mailing Address - Phone:714-399-1860
Mailing Address - Fax:
Practice Address - Street 1:341 E. CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:90201-3323
Practice Address - Country:US
Practice Address - Phone:714-399-1860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator