Healthcare Provider Details

I. General information

NPI: 1861941460
Provider Name (Legal Business Name): COLE OLMON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2016
Last Update Date: 09/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S REINO RD SUITE 100
NEWBURY PARK CA
91320-4284
US

IV. Provider business mailing address

400 S REINO RD SUITE 100
NEWBURY PARK CA
91320-4284
US

V. Phone/Fax

Practice location:
  • Phone: 805-277-2233
  • Fax: 805-277-0623
Mailing address:
  • Phone: 805-277-2233
  • Fax: 805-277-0623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number292037
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: