Healthcare Provider Details

I. General information

NPI: 1790173664
Provider Name (Legal Business Name): ROSANA ALEJANDRA OLVERA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2014
Last Update Date: 12/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 MARIPOSA ST
LA HABRA CA
90631-6308
US

IV. Provider business mailing address

801 MARIPOSA ST
LA HABRA CA
90631-6308
US

V. Phone/Fax

Practice location:
  • Phone: 562-896-3388
  • Fax:
Mailing address:
  • Phone: 562-896-3388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95001646
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: