Individual
MNAUEL FERNANDO OLIVAREZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2085 RUSTIN AVE, RIVERSIDE, CA 92507-2498
(951) 374-3516
Mailing address
2085 RUSTIN AVE, RIVERSIDE, CA 92507-2498
(951) 358-4100
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
171M00000X
CA
172A00000X
Driver
Primary
—
—
253J00000X
Foster Care Agency
171M00000X
CA
Other
Enumeration date
09/21/2016
Last updated
04/21/2017
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