Healthcare Provider Details

I. General information

NPI: 1134618218
Provider Name (Legal Business Name): ELBA ELIZABETH OLMEDO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2018
Last Update Date: 05/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 BELLFLOWER BLVD
DOWNEY CA
90242-2804
US

IV. Provider business mailing address

12200 BELLFLOWER BLVD
DOWNEY CA
90242-2804
US

V. Phone/Fax

Practice location:
  • Phone: 562-622-4328
  • Fax:
Mailing address:
  • Phone: 562-622-4328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW66849
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: