Healthcare Provider Details

I. General information

NPI: 1104779503
Provider Name (Legal Business Name): MARCO ANTONIO OLEA JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N NORMA ST STE 125
RIDGECREST CA
93555-2577
US

IV. Provider business mailing address

2821 H ST
BAKERSFIELD CA
93301-1913
US

V. Phone/Fax

Practice location:
  • Phone: 760-499-7406
  • Fax:
Mailing address:
  • Phone: 661-546-6365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: