Healthcare Provider Details

I. General information

NPI: 1114836707
Provider Name (Legal Business Name): ANGELICA NICOLE OLIVAS RN, BSN, MSN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11116 WICKS ST
SUN VALLEY CA
91352-1244
US

IV. Provider business mailing address

11116 WICKS ST
SUN VALLEY CA
91352-1244
US

V. Phone/Fax

Practice location:
  • Phone: 818-454-0001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number95323118
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: