Healthcare Provider Details

I. General information

NPI: 1902262934
Provider Name (Legal Business Name): SCOTT OLOMANU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2016
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5155 W ROSECRANS AVE STE 100
HAWTHORNE CA
90250-6652
US

IV. Provider business mailing address

3600 WILSHIRE BLVD STE 1500
LOS ANGELES CA
90010-2619
US

V. Phone/Fax

Practice location:
  • Phone: 310-493-4177
  • Fax:
Mailing address:
  • Phone: 213-388-8280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: