Healthcare Provider Details

I. General information

NPI: 1598161309
Provider Name (Legal Business Name): LUISA OLVERA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2014
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 MEDICAL CENTER CT
CHULA VISTA CA
91911-6617
US

IV. Provider business mailing address

1786 SUNNY CREST LN
BONITA CA
91902-4057
US

V. Phone/Fax

Practice location:
  • Phone: 619-502-5800
  • Fax:
Mailing address:
  • Phone: 619-805-6702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95001710
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: