Healthcare Provider Details

I. General information

NPI: 1538340369
Provider Name (Legal Business Name): MARIELA OLMEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 06/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S WELLS RD
VENTURA CA
93004-1377
US

IV. Provider business mailing address

200 S WELLS RD
VENTURA CA
93004-1377
US

V. Phone/Fax

Practice location:
  • Phone: 805-659-1740
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6635928-3503
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number30553
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: