Healthcare Provider Details

I. General information

NPI: 1942931795
Provider Name (Legal Business Name): ANISSA OLONA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 S ST LOUIS ST
LOS ANGELES CA
90033-4320
US

IV. Provider business mailing address

560 S ST LOUIS ST
LOS ANGELES CA
90033-4320
US

V. Phone/Fax

Practice location:
  • Phone: 213-480-1557
  • Fax:
Mailing address:
  • Phone: 213-480-1557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: