Healthcare Provider Details

I. General information

NPI: 1952018848
Provider Name (Legal Business Name): ANDREA OLMOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2022
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5850 ATLANTIC AVE STE 112
DELRAY BEACH FL
33484-8427
US

IV. Provider business mailing address

5850 ATLANTIC AVE STE 112
DELRAY BEACH FL
33484-8427
US

V. Phone/Fax

Practice location:
  • Phone: 561-336-0358
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: