Healthcare Provider Details

I. General information

NPI: 1528314440
Provider Name (Legal Business Name): ANDREA OLMOS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2012
Last Update Date: 12/22/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 PARNASSUS AVE #S436
SAN FRANCISCO CA
94143-2205
US

IV. Provider business mailing address

513 PARNASSUS AVE #S436
SAN FRANCISCO CA
94143-2205
US

V. Phone/Fax

Practice location:
  • Phone: 415-514-3781
  • Fax: 415-514-0185
Mailing address:
  • Phone: 415-514-3781
  • Fax: 415-514-0185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA129070
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: