Healthcare Provider Details

I. General information

NPI: 1457582439
Provider Name (Legal Business Name): KAREN ELISA MILIAN OLMOS M.D., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2009
Last Update Date: 11/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 LOMITA BLVD SUITE 102
HARBOR CITY CA
90710-2076
US

IV. Provider business mailing address

1403 LOMITA BLVD SUITE 103
HARBOR CITY CA
90710-2076
US

V. Phone/Fax

Practice location:
  • Phone: 310-534-7600
  • Fax:
Mailing address:
  • Phone: 310-534-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA114027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: