Healthcare Provider Details

I. General information

NPI: 1033706155
Provider Name (Legal Business Name): MARLEN OLMOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15095 AMARGOSA RD STE 208
VICTORVILLE CA
92394-1879
US

IV. Provider business mailing address

15095 AMARGOSA RD STE 208
VICTORVILLE CA
92394-1875
US

V. Phone/Fax

Practice location:
  • Phone: 760-338-5492
  • Fax:
Mailing address:
  • Phone: 909-936-3527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: