Melquiades Olivares Jr., M.D,

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

90265 Issued in NM

Practice address

260 Mills Ave
Las Vegas, NM 87701-4125

Phone

(505) 425-6731

Fax

(505) 454-9193

NPI assigned

Aug 1, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Mel Olivares Jr. Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mesa Medical LLC

  • Family Nurse Practitioner
  • Las Vegas, NM
  • NPI 1154416584
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1276819200000",
    "number": "1629084272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 MILLS AVE",
            "city": "LAS VEGAS",
            "state": "NM",
            "postal_code": "877014125",
            "telephone_number": "505-425-6731",
            "fax_number": "505-454-9193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 MILLS AVE",
            "city": "LAS VEGAS",
            "state": "NM",
            "postal_code": "877014125",
            "telephone_number": "505-425-6731",
            "fax_number": "505-454-9193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLIVARES",
        "first_name": "MELQUIADES",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D,",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2010-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NM",
            "license": "90265",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00042138",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MEL",
            "last_name": "OLIVARES",
            "prefix": "DR.",
            "suffix": "JR.",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Teresa Ann O'Brien, MD
• Jennifer O'Neil, CPSW
• Oasis Therapy LLC
• Rosalie Delfina Obregon, LISW
• Theresa Okoro, CNM
• McKenna Oney, PHARMD
• Open Doors Home Health Care
• Open House LLC
• Brandon M Ortega
• Derrick A Ortega

• General Practice Physician in Las Vegas, NM
• Providers in Las Vegas, NM by specialty
• General Practice Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.