Provider Demographics
NPI:1154625408
Name:SHIMIZU OLIVA, GRACIELA (DDS, MSD)
Entity type:Individual
Prefix:
First Name:GRACIELA
Middle Name:
Last Name:SHIMIZU OLIVA
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 UNIVERSITY DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4203
Mailing Address - Country:US
Mailing Address - Phone:650-600-8206
Mailing Address - Fax:
Practice Address - Street 1:1300 UNIVERSITY DR
Practice Address - Street 2:SUITE 1
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4203
Practice Address - Country:US
Practice Address - Phone:650-600-8206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-30
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014130181223P0700X
CA618831223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics