Provider Demographics
NPI:1902437437
Name:OLVERA, ANNA KAREN
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:KAREN
Last Name:OLVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 ESCONDIDO
Mailing Address - Street 2:
Mailing Address - City:HATCH
Mailing Address - State:NM
Mailing Address - Zip Code:87937
Mailing Address - Country:US
Mailing Address - Phone:575-222-3404
Mailing Address - Fax:
Practice Address - Street 1:175 ESCONDIDO
Practice Address - Street 2:
Practice Address - City:HATCH
Practice Address - State:NM
Practice Address - Zip Code:87937
Practice Address - Country:US
Practice Address - Phone:575-222-3404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty