Provider Demographics
NPI:1700630431
Name:OLIVARES, GEMARUBY
Entity type:Individual
Prefix:MS
First Name:GEMARUBY
Middle Name:
Last Name:OLIVARES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GEMARUBY
Other - Middle Name:
Other - Last Name:OLIVARES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:10214 E 44TH ST # 32
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-3709
Mailing Address - Country:US
Mailing Address - Phone:918-845-6092
Mailing Address - Fax:
Practice Address - Street 1:10214 E 44TH ST # 32
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-3709
Practice Address - Country:US
Practice Address - Phone:918-845-6092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist