Healthcare Provider Details

I. General information

NPI: 1912558685
Provider Name (Legal Business Name): KATHYA OLMOS LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 SERRANIA AVE
WOODLAND HILLS CA
91364-3301
US

IV. Provider business mailing address

4900 SERRANIA AVE
WOODLAND HILLS CA
91364-3301
US

V. Phone/Fax

Practice location:
  • Phone: 323-443-3175
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number706296
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: