Healthcare Provider Details

I. General information

NPI: 1679480339
Provider Name (Legal Business Name): OLIVE CREST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7220 TRADE ST STE 103
SAN DIEGO CA
92121-2325
US

IV. Provider business mailing address

2130 E 4TH ST
SANTA ANA CA
92705-3818
US

V. Phone/Fax

Practice location:
  • Phone: 858-389-0010
  • Fax:
Mailing address:
  • Phone:
  • 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: TINA MARIE CHANG
Title or Position: REGIONAL PROGRAMS DIRECTOR
Credential:
Phone: 714-543-5437