Provider Demographics
NPI:1144649153
Name:FUNES, OLIVIA A (PA-C)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:A
Last Name:FUNES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:A
Other - Last Name:VILLANUEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4499 MEDICAL DR
Mailing Address - Street 2:SUITE 151A
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3735
Mailing Address - Country:US
Mailing Address - Phone:210-593-4392
Mailing Address - Fax:210-593-0152
Practice Address - Street 1:4499 MEDICAL DR
Practice Address - Street 2:SUITE 151A
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3735
Practice Address - Country:US
Practice Address - Phone:210-593-4392
Practice Address - Fax:210-593-0152
Is Sole Proprietor?:No
Enumeration Date:2014-04-08
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09093363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant