Healthcare Provider Details

I. General information

NPI: 1366550113
Provider Name (Legal Business Name): YOLANDA OLVEA D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 05/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 W BEVERLY BLVD
MONTEBELLO CA
90640-3624
US

IV. Provider business mailing address

616 W BEVERLY BLVD
MONTEBELLO CA
90640-3624
US

V. Phone/Fax

Practice location:
  • Phone: 323-721-2000
  • Fax:
Mailing address:
  • Phone: 323-721-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number26050
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: