Healthcare Provider Details

I. General information

NPI: 1821818444
Provider Name (Legal Business Name): RENE OLMOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/17/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12501 IMPERIAL HWY STE 230
NORWALK CA
90650-1430
US

IV. Provider business mailing address

555 E CARSON ST UNIT 87
CARSON CA
90745-2726
US

V. Phone/Fax

Practice location:
  • Phone: 714-881-0427
  • Fax:
Mailing address:
  • Phone: 310-940-5313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: