Healthcare Provider Details

I. General information

NPI: 1063140317
Provider Name (Legal Business Name): OLIVIA MIDBY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3619 N MISSION RD
LINCOLN HEIGHTS CA
90031-3136
US

IV. Provider business mailing address

4445 BURNS AVE
LOS ANGELES CA
90029-2702
US

V. Phone/Fax

Practice location:
  • Phone: 213-721-0100
  • Fax:
Mailing address:
  • Phone: 323-222-1440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: