Healthcare Provider Details

I. General information

NPI: 1659650216
Provider Name (Legal Business Name): JOCELYN C OLMAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2011
Last Update Date: 08/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 TORRANCE BLVD STE 780
TORRANCE CA
90503-4511
US

IV. Provider business mailing address

456 S VENICE BLVD
VENICE CA
90291-4644
US

V. Phone/Fax

Practice location:
  • Phone: 310-543-2532
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19187
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: