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NPI Code Detail

MEDICARE: MR. JOSE ANGEL OLMO JR.

MEDICARE: MR. JOSE ANGEL OLMO JR.
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1669199592
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOSE ANGEL OLMO JR.
Provider Business Mailing Address
First Line : 790 GOODWIN ST
Second Line :
City : EAST HARTFORD
State : CT
Zip : 06108-1204
Country : US
Telephone Number : 860-718-6015
Fax Number :
Provider Business Practice Location Address
First Line : 77 HARTLAND ST
Second Line :
City : EAST HARTFORD
State : CT
Zip : 06108-6201
Country : US
Telephone Number : 888-754-0398
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2022
Last Update Date : 10/21/2022

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Directions to “ MR. JOSE ANGEL OLMO JR. ” Practice Location

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