Healthcare Provider Details

I. General information

NPI: 1851085328
Provider Name (Legal Business Name): JULIA MARIE OLSEN LOVE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIA MARIE OLSEN DO

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3883 AIRWAY DR
SANTA ROSA CA
95403-1670
US

IV. Provider business mailing address

3883 AIRWAY DR
SANTA ROSA CA
95403-1670
US

V. Phone/Fax

Practice location:
  • Phone: 707-521-7777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTL.0009967
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A25391
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: