Healthcare Provider Details

I. General information

NPI: 1154157311
Provider Name (Legal Business Name): PAULINA REBECCA OLVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2024
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 GEORGIA ST
VALLEJO CA
94590-6004
US

IV. Provider business mailing address

625 OREGON ST
SONOMA CA
95476-6439
US

V. Phone/Fax

Practice location:
  • Phone: 707-556-8100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: