Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003210311 |
---|---|
Provider Name | Mr. John Eugene Oliveira III |
First Address | Tracy, CA 95376-4349 |
Second Address | Tracy, CA 95376-4349 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2014 |
Last Update Date | 15/10/2014 |