Healthcare Provider Details

I. General information

NPI: 1316575574
Provider Name (Legal Business Name): OLENKA CAFFO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 BICKFORD AVE STE 211
SNOHOMISH WA
98290-1751
US

IV. Provider business mailing address

PO BOX 31001 4114
PASADENA CA
91110-4114
US

V. Phone/Fax

Practice location:
  • Phone: 360-563-5900
  • Fax: 425-259-8600
Mailing address:
  • Phone: 360-563-5900
  • Fax: 425-259-8600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61381815
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1016872
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: