Healthcare Provider Details

I. General information

NPI: 1730806860
Provider Name (Legal Business Name): DAISY OLAYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 10/19/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N HILL AVE STE 100
PASADENA CA
91106-1949
US

IV. Provider business mailing address

1549 LAUREL AVE
POMONA CA
91768-2846
US

V. Phone/Fax

Practice location:
  • Phone: 626-793-7700
  • Fax:
Mailing address:
  • Phone: 909-762-9205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberF7831812
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: