Healthcare Provider Details

I. General information

NPI: 1447688429
Provider Name (Legal Business Name): RODOLFO OLMOS CADC II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 03/27/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14515 HAMLIN ST
VAN NUYS CA
91411-1686
US

IV. Provider business mailing address

14515 HAMLIN ST
VAN NUYS CA
91411-1686
US

V. Phone/Fax

Practice location:
  • Phone: 213-624-9258
  • Fax:
Mailing address:
  • Phone: 818-290-2643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAII057750518
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: