Healthcare Provider Details

I. General information

NPI: 1174607667
Provider Name (Legal Business Name): ROBERT A OLSON CRNA, M.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 02/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N ROXBURY DR SUITE 600
BEVERLY HILLS CA
90210-4232
US

IV. Provider business mailing address

7254 HOLLYWOOD BLVD APT 4
LOS ANGELES CA
90046-3117
US

V. Phone/Fax

Practice location:
  • Phone: 310-651-2280
  • Fax: 310-651-2260
Mailing address:
  • Phone: 323-876-7934
  • Fax: 323-876-7934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3404
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number200960007CRNA
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: