Healthcare Provider Details

I. General information

NPI: 1821181553
Provider Name (Legal Business Name): HUITZILIN M OLMECAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11175 CAMPUS ST DEPARTMENT OF NEUROLOGY, COLEMAN PAVILION - RM. 11108
LOMA LINDA CA
92350-1700
US

IV. Provider business mailing address

11175 CAMPUS ST DEPARTMENT OF NEUROLOGY, COLEMAN PAVILION - RM. 11108
LOMA LINDA CA
92350-1700
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-4907
  • Fax: 909-558-0207
Mailing address:
  • Phone: 909-558-4907
  • Fax: 909-558-0207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberA94960
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number22784
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number35.120019
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number01068637A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2022-01700
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD2022-1364
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: