Healthcare Provider Details

I. General information

NPI: 1659597292
Provider Name (Legal Business Name): STEVE OLMO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 N VAN NESS AVE
FRESNO CA
93728-3419
US

IV. Provider business mailing address

190 N WILLOW AVE APT 108
FRESNO CA
93727-3075
US

V. Phone/Fax

Practice location:
  • Phone: 559-266-9581
  • Fax: 559-498-0507
Mailing address:
  • Phone: 559-266-9581
  • Fax: 559-498-0507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: