Healthcare Provider Details

I. General information

NPI: 1518018183
Provider Name (Legal Business Name): LORRAINE ANNA COLACION OLSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 12/08/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25965 NORMANDIE AVE
HARBOR CITY CA
90710-3416
US

IV. Provider business mailing address

11671 NORGROVE LN
ROSSMOOR CA
90720-4025
US

V. Phone/Fax

Practice location:
  • Phone: 310-517-4417
  • Fax: 310-517-4103
Mailing address:
  • Phone: 562-596-1004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA11444
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: