Healthcare Provider Details

I. General information

NPI: 1982737417
Provider Name (Legal Business Name): DAVID JAMES OLSON CAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 BEACH COURT
COLOMA CA
95613
US

IV. Provider business mailing address

3341 SLY PARK RD
POLLOCK PINES CA
95726-9519
US

V. Phone/Fax

Practice location:
  • Phone: 530-626-7252
  • Fax:
Mailing address:
  • Phone: 530-644-7021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number03-991219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: