Provider Demographics
NPI:1760626675
Name:DE OLIVEIRA, ALCIDES ANTONIO (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MR
First Name:ALCIDES
Middle Name:ANTONIO
Last Name:DE OLIVEIRA
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
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Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-579-3203
Mailing Address - Fax:
Practice Address - Street 1:229 S GLASSELL ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-1945
Practice Address - Country:US
Practice Address - Phone:714-997-2899
Practice Address - Fax:714-639-3708
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA17935363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily