Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | K5647 | TX |
N | 2080P0207X | Pediatric Hematology-Oncologist | K5647 | TX |
NPI | 1144326257 |
---|---|
Provider Name | Rebecca E Olvera |
First Address | Dallas, TX 75373-3784 |
Second Address | Fort Worth, TX 76109-4115 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 19/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H82697 | (02) |