Healthcare Provider Details

I. General information

NPI: 1548749476
Provider Name (Legal Business Name): JENNIFER OLHA BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2018
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 SPRUCE ST STE 250
RIVERSIDE CA
92507-7429
US

IV. Provider business mailing address

138 CUYAHOGA CT
PERRIS CA
92570-5581
US

V. Phone/Fax

Practice location:
  • Phone: 951-230-6191
  • Fax:
Mailing address:
  • Phone: 951-230-6191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: