Healthcare Provider Details

I. General information

NPI: 1194608935
Provider Name (Legal Business Name): OLIVIA GRACE THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

679 S NEW HAMPSHIRE AVE FL 4
LOS ANGELES CA
90005-1355
US

IV. Provider business mailing address

679 S NEW HAMPSHIRE AVE FL 4
LOS ANGELES CA
90005-1355
US

V. Phone/Fax

Practice location:
  • Phone: 213-639-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: