Healthcare Provider Details

I. General information

NPI: 1942963830
Provider Name (Legal Business Name): OSCAR A OLATE FUENTES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2021
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 W TUNNELL ST
SANTA MARIA CA
93458-4096
US

IV. Provider business mailing address

813 LAGUNA AVE
SANTA MARIA CA
93454-6724
US

V. Phone/Fax

Practice location:
  • Phone: 805-614-4940
  • Fax:
Mailing address:
  • Phone: 805-868-5634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number33991
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: