Healthcare Provider Details

I. General information

NPI: 1790526713
Provider Name (Legal Business Name): ALISHA ROBIN OLMO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 06/04/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 MYRTLE AVENUE
EUREKA CA
95501-1219
US

IV. Provider business mailing address

901 MYRTLE AVENUE
EUREKA CA
95501-1219
US

V. Phone/Fax

Practice location:
  • Phone: 707-445-7000
  • Fax: 707-445-7143
Mailing address:
  • Phone: 707-445-7000
  • Fax: 707-445-7143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number36742
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: