Healthcare Provider Details

I. General information

NPI: 1205500428
Provider Name (Legal Business Name): OLIVIA S WETTER MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8073 BROADWAY
LEMON GROVE CA
91945-2533
US

IV. Provider business mailing address

8073 BROADWAY
LEMON GROVE CA
91945-2533
US

V. Phone/Fax

Practice location:
  • Phone: 619-677-5212
  • Fax:
Mailing address:
  • Phone: 619-677-5212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number260131458
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: