Healthcare Provider Details

I. General information

NPI: 1285588210
Provider Name (Legal Business Name): MADELINE CLAIRE OLSEN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 ALPINE BLVD
ALPINE CA
91901-2113
US

IV. Provider business mailing address

3950 MAHAILA AVE APT T23
SAN DIEGO CA
92122-6125
US

V. Phone/Fax

Practice location:
  • Phone: 619-445-2644
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: