Healthcare Provider Details

I. General information

NPI: 1407210891
Provider Name (Legal Business Name): KARLA PATRICIA OLMEDO GUTIERREZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARLA OLMEDO

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 12/04/2023
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1043 ELM AVE STE 104
LONG BEACH CA
90813-3244
US

IV. Provider business mailing address

PO BOX 512185
LOS ANGELES CA
90051-0185
US

V. Phone/Fax

Practice location:
  • Phone: 562-590-0345
  • Fax: 562-437-8139
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberA159385
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA159385
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: