Provider Demographics
NPI:1124061015
Name:OLIVO, JULIE LOMONACO (MD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:LOMONACO
Last Name:OLIVO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 AIRPORT FWY STE 320
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-1116
Mailing Address - Country:US
Mailing Address - Phone:817-684-3500
Mailing Address - Fax:817-684-3510
Practice Address - Street 1:1305 AIRPORT FWY STE 320
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-1116
Practice Address - Country:US
Practice Address - Phone:817-684-3500
Practice Address - Fax:817-684-3510
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8462208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168348401Medicaid
TX168348402Medicaid
TX168348402Medicaid
TX8C6385Medicare PIN
TX168348402Medicaid