Healthcare Provider Details

I. General information

NPI: 1649098799
Provider Name (Legal Business Name): OLIVIA JENNIFER TECCE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 SOQUEL DR
SOQUEL CA
95073-2427
US

IV. Provider business mailing address

4700 SOQUEL DR
SOQUEL CA
95073-2427
US

V. Phone/Fax

Practice location:
  • Phone: 831-888-9410
  • Fax:
Mailing address:
  • Phone: 831-888-9410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number65112
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: