Healthcare Provider Details

I. General information

NPI: 1497242762
Provider Name (Legal Business Name): GEORGE LEO R OLARTE NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2018
Last Update Date: 04/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3417 W CANOGA PL APT 1
ANAHEIM CA
92804-2752
US

IV. Provider business mailing address

3417 W CANOGA PL APT 1
ANAHEIM CA
92804-2752
US

V. Phone/Fax

Practice location:
  • Phone: 714-851-6109
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95008856
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: