Healthcare Provider Details

I. General information

NPI: 1184219388
Provider Name (Legal Business Name): JANINE OLMOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 01/11/2024
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6737 BRIGHT AVE
WHITTIER CA
90601-4300
US

IV. Provider business mailing address

18902 VAN NESS AVE
TORRANCE CA
90504-6112
US

V. Phone/Fax

Practice location:
  • Phone: 562-373-2622
  • Fax:
Mailing address:
  • Phone: 310-961-0080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT142562
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: