Healthcare Provider Details

I. General information

NPI: 1487561874
Provider Name (Legal Business Name): KATRINA OLIVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8160 DAY CREEK BLVD
RANCHO CUCAMONGA CA
91739-8549
US

IV. Provider business mailing address

8160 DAY CREEK BLVD
RANCHO CUCAMONGA CA
91739-8549
US

V. Phone/Fax

Practice location:
  • Phone: 909-825-7084
  • Fax: 909-422-3006
Mailing address:
  • Phone: 909-825-7084
  • Fax: 909-422-3006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number71463
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: