Basic Information
| Provider Information | |||||||||
| NPI: | 1457861130 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OLIVARES | ||||||||
| FirstName: | VERONICA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2141 PALOMAR AIRPORT RD STE 350 | ||||||||
| Address2: | |||||||||
| City: | CARLSBAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920111451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607102460 | ||||||||
| FaxNumber: | 8778396751 | ||||||||
| Practice Location | |||||||||
| Address1: | 2141 PALOMAR AIRPORT RD STE 350 | ||||||||
| Address2: | |||||||||
| City: | CARLSBAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920111451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607102460 | ||||||||
| FaxNumber: | 8778396751 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2017 | ||||||||
| LastUpdateDate: | 03/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | CA | Y |
No ID Information.