Healthcare Provider Details

I. General information

NPI: 1427727718
Provider Name (Legal Business Name): OLIVIA DALTON NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNARD DR RM 3326
OCEANSIDE CA
92056-3820
US

IV. Provider business mailing address

638 22ND ST
SAN DIEGO CA
92102-2909
US

V. Phone/Fax

Practice location:
  • Phone: 760-795-6675
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95015042
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: