Healthcare Provider Details

I. General information

NPI: 1174096937
Provider Name (Legal Business Name): EMILIA OLAVARRIETA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 FORREST AVE
FAIRFAX CA
94930-1801
US

IV. Provider business mailing address

91 FORREST AVE
FAIRFAX CA
94930-1801
US

V. Phone/Fax

Practice location:
  • Phone: 415-299-1563
  • Fax:
Mailing address:
  • Phone: 415-299-1563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: