Provider Demographics
NPI:1053899229
Name:OLIVAREZ, MARTA SHAIDY (RN)
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:SHAIDY
Last Name:OLIVAREZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 KIMBERLY ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6383
Mailing Address - Country:US
Mailing Address - Phone:956-838-9422
Mailing Address - Fax:
Practice Address - Street 1:122 KIMBERLY ST
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6383
Practice Address - Country:US
Practice Address - Phone:956-838-9422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX765428163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1790847531Medicaid