Healthcare Provider Details

I. General information

NPI: 1194922567
Provider Name (Legal Business Name): ROSA ELENA OLMOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 PEAR TREE LN STE 100
NAPA CA
94558
US

IV. Provider business mailing address

1141 PEAR TREE LN
NAPA CA
94558-6484
US

V. Phone/Fax

Practice location:
  • Phone: 707-254-1770
  • Fax: 707-254-1779
Mailing address:
  • Phone: 707-254-1770
  • Fax: 707-254-1779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW83201
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: