Healthcare Provider Details

I. General information

NPI: 1619866415
Provider Name (Legal Business Name): ALEXANDER OLSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2025
Last Update Date: 06/28/2025
Certification Date: 06/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 FLORIDA AVE
MODESTO CA
95350-4404
US

IV. Provider business mailing address

31 ARGOSY BEND PL
TOMBALL TX
77375-1451
US

V. Phone/Fax

Practice location:
  • Phone: 509-499-9421
  • Fax:
Mailing address:
  • Phone: 509-499-9421
  • 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: