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General NPI Number Information
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NPI Number | 1649906819
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Entity Type | Individual
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Provider Name | MARCUS OLSEN PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/28/2022
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 2039 FOREST AVE STE 201
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City | SAN JOSE
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State | CA
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Zip | 95128-4815
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Country | US
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Telephone | 408-358-8090
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Fax |
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Provider Business Mailing Address
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Address Line | 9301 WILSHIRE BLVD STE 506
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-6189
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Country | US
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Telephone | 424-239-5981
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number |
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License Number State |
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