Healthcare Provider Details

I. General information

NPI: 1871636860
Provider Name (Legal Business Name): MELINDA B OLIVAS PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11741 TELEGRAPH RD STE G
SANTA FE SPRINGS CA
90670-3687
US

IV. Provider business mailing address

PO BOX 203
SAN DIMAS CA
91773-0203
US

V. Phone/Fax

Practice location:
  • Phone: 562-942-8256
  • Fax:
Mailing address:
  • Phone: 800-275-8777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberRPS 2012150
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: