MEDICARE: CHARLIE QUIJANO OLIVAR BT

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
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1437091824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLIE QUIJANO OLIVAR BT

Provider Business Mailing Address
First Line	:	245 FAMOSO PLZ
Second Line	:
City	:	UNION CITY
State	:	CA
Zip	:	94587-3745
Country	:	US
Telephone Number	:	510-589-1124
Fax Number	:

Provider Business Practice Location Address
First Line	:	245 FAMOSO PLZ
Second Line	:
City	:	UNION CITY
State	:	CA
Zip	:	94587-3745
Country	:	US
Telephone Number	:	510-589-1124
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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