Provider Demographics
NPI:1699710418
Name:NEPHROLOGY PA
Entity type:Organization
Organization Name:NEPHROLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:OLIVERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-790-4615
Mailing Address - Street 1:6560 FANNIN ST
Mailing Address - Street 2:2206
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2761
Mailing Address - Country:US
Mailing Address - Phone:713-790-4615
Mailing Address - Fax:713-790-5878
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:2206
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2761
Practice Address - Country:US
Practice Address - Phone:713-790-4615
Practice Address - Fax:713-790-5878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0069AEMedicare ID - Type UnspecifiedGROUP MEDICARE ID