Healthcare Provider Details

I. General information

NPI: 1083364277
Provider Name (Legal Business Name): MICHAEL PATRICK OLVERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 X ST STE 3016
SACRAMENTO CA
95817-2229
US

IV. Provider business mailing address

757 WESTWOOD PLAZA, INTERNAL MEDICINE
LOS ANGELES CA
90095-7419
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-5959
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA189326
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: