Healthcare Provider Details

I. General information

NPI: 1508908500
Provider Name (Legal Business Name): VERONICA I OLVERA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 S BEVERLY DR SUITE 225
BEVERLY HILLS CA
90212-3817
US

IV. Provider business mailing address

226 S BEVERLY DR SUITE 225
BEVERLY HILLS CA
90212-3817
US

V. Phone/Fax

Practice location:
  • Phone: 310-273-4843
  • Fax: 310-273-5056
Mailing address:
  • Phone: 310-273-4843
  • Fax: 310-273-5056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY 23490
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: