Healthcare Provider Details

I. General information

NPI: 1861484651
Provider Name (Legal Business Name): ANGELIQUE OLSZOWKA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG H100 SANTA MARGARITA ROAD ATTENTION: CODE CS-PA
CAM PENDLETON CA
92055
US

IV. Provider business mailing address

PO BOX 500231
SAN DIEGO CA
92150-0231
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1330
  • Fax:
Mailing address:
  • Phone: 858-385-1431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA64377
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: