Provider Demographics
NPI:1083463277
Name:OLIVAS, ANDREA MARISSA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:MARISSA
Last Name:OLIVAS
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:3280 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-2412
Mailing Address - Country:US
Mailing Address - Phone:530-886-8630
Mailing Address - Fax:530-886-8629
Practice Address - Street 1:3280 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-2412
Practice Address - Country:US
Practice Address - Phone:530-886-8630
Practice Address - Fax:530-886-8629
Is Sole Proprietor?:No
Enumeration Date:2024-05-18
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA64496363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant