Healthcare Provider Details

I. General information

NPI: 1255064259
Provider Name (Legal Business Name): KARINA OLMOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 PERCY ST
LOS ANGELES CA
90023-1716
US

IV. Provider business mailing address

7121 CEDAR ST
HUNTINGTON PARK CA
90255-5247
US

V. Phone/Fax

Practice location:
  • Phone: 323-268-2100
  • Fax: 323-983-7530
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 State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: