Healthcare Provider Details

I. General information

NPI: 1841450509
Provider Name (Legal Business Name): PEDRO OLEA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3945 WHITTIER BLVD
LOS ANGELES CA
90023-2440
US

IV. Provider business mailing address

3945 WHITTIER BLVD
LOS ANGELES CA
90023-2440
US

V. Phone/Fax

Practice location:
  • Phone: 323-265-1998
  • Fax: 323-201-3238
Mailing address:
  • Phone: 323-265-1998
  • Fax: 323-201-3238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA116742
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: