Healthcare Provider Details

I. General information

NPI: 1003349135
Provider Name (Legal Business Name): REBECCA OLVEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2017
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 DUBLIN BLVD
DUBLIN CA
94568-3112
US

IV. Provider business mailing address

325 DISTEL CIR
LOS ALTOS CA
94022-1408
US

V. Phone/Fax

Practice location:
  • Phone: 925-875-6100
  • Fax:
Mailing address:
  • Phone: 925-875-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number161557
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: