Healthcare Provider Details

I. General information

NPI: 1982166518
Provider Name (Legal Business Name): ADRIANA MARTINEZ OLIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26585 AGOURA RD STE 360
CALABASAS CA
91302-1958
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 818-592-2320
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA180132
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: