Healthcare Provider Details

I. General information

NPI: 1609990555
Provider Name (Legal Business Name): SUSAN OLFERT R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E MURRAY AVE
VISALIA CA
93291-5053
US

IV. Provider business mailing address

2507 BIRCH CT
KINGSBURG CA
93631-1455
US

V. Phone/Fax

Practice location:
  • Phone: 559-625-4003
  • Fax: 559-625-4113
Mailing address:
  • Phone: 559-897-4587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number819233
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: