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NPI Code Detail

MEDICARE: OLIVIA JANAE PARKS

MEDICARE:   OLIVIA JANAE PARKS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1275319071
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLIVIA JANAE PARKS
Provider Business Mailing Address
First Line : 1901 CEDAR AVE APT 1
Second Line :
City : LONG BEACH
State : CA
Zip : 90806-5339
Country : US
Telephone Number : 562-477-1908
Fax Number :
Provider Business Practice Location Address
First Line : 1901 CEDAR AVE APT 1
Second Line :
City : LONG BEACH
State : CA
Zip : 90806-5339
Country : US
Telephone Number : 562-477-1908
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2023
Last Update Date : 09/06/2023

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Directions to “ OLIVIA JANAE PARKS ” Practice Location

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