Healthcare Provider Details

I. General information

NPI: 1033684865
Provider Name (Legal Business Name): LUA OLIVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2018
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CONCAR DR STE 4-134
SAN MATEO CA
94402-2681
US

IV. Provider business mailing address

5504 ASPEN GROVE LN
ELK GROVE CA
95757
US

V. Phone/Fax

Practice location:
  • Phone: 650-931-6300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: