Active NPI
Myra Jill Olivas, RD
- Registered Dietitian
- Albuquerque, NM
National Provider Identifier
1962679720
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- LD-0564
- Practice address
- 4701 Montgomery Blvd NE
Albuquerque, NM 87109-1219 - Phone
- (505) 727-7819
- NPI assigned
- May 12, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | LD-0564 | NM | Primary |
Addresses
Primary practice location
4701 Montgomery Blvd NE
Albuquerque, NM 87109-1219
Mailing address
10823 Monterey Bay CT NW
Albuquerque, NM 87114-1998
Phone (505) 792-1014
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210550400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210550400000",
"number": "1962679720",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10823 MONTEREY BAY CT NW",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871141998",
"telephone_number": "505-792-1014"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4701 MONTGOMERY BLVD NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871091219",
"telephone_number": "505-727-7819"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLIVAS",
"first_name": "MYRA",
"middle_name": "JILL",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-05-12",
"last_updated": "2008-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NM",
"license": "LD-0564",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.