Healthcare Provider Details

I. General information

NPI: 1821344482
Provider Name (Legal Business Name): STEVEN RUBEN OLMOS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7879 EL CAJON BLVD
LA MESA CA
91942-0623
US

IV. Provider business mailing address

7879 EL CAJON BLVD
LA MESA CA
91942-0623
US

V. Phone/Fax

Practice location:
  • Phone: 619-466-2774
  • Fax: 619-466-2873
Mailing address:
  • Phone: 619-466-2774
  • Fax: 619-466-2873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number29641
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: