Healthcare Provider Details

I. General information

NPI: 1841710159
Provider Name (Legal Business Name): MR. ALAN OLMEDO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 E 17TH STREET
SANTA ANA CA
92705
US

IV. Provider business mailing address

1615 E 17TH ST
SANTA ANA CA
92705-8529
US

V. Phone/Fax

Practice location:
  • Phone: 714-949-0284
  • Fax: 714-541-7924
Mailing address:
  • Phone: 714-949-0284
  • Fax: 714-541-7924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: