Provider Demographics
NPI:1124291828
Name:OLIVEIRA, THOMAS EDWARD (DO)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:EDWARD
Last Name:OLIVEIRA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 W GRAHAM AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-3666
Mailing Address - Country:US
Mailing Address - Phone:951-471-5116
Mailing Address - Fax:
Practice Address - Street 1:506 W GRAHAM AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-3666
Practice Address - Country:US
Practice Address - Phone:951-471-5116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7032208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG24057Medicare UPIN