Healthcare Provider Details

I. General information

NPI: 1285126433
Provider Name (Legal Business Name): CHRISTINA OLIVEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 08/19/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2271 ALPINE BLVD STE A
ALPINE CA
91901-1101
US

IV. Provider business mailing address

1330 MARKET ST APT 635
SAN DIEGO CA
92101-7690
US

V. Phone/Fax

Practice location:
  • Phone: 888-688-0248
  • Fax:
Mailing address:
  • Phone: 619-394-3362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number147714
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: