=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952559114
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. APPOLONIA OLUMBA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2008
-----------------------------------------------------
Last Update Date | 01/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17034 BELLFLOWER BLVD
-----------------------------------------------------
City | BELLFLOWER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90706-5950
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-991-1568
-----------------------------------------------------
Fax | 562-991-1581
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17034 BELLFLOWER BLVD
-----------------------------------------------------
City | BELLFLOWER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90706-5950
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-991-1568
-----------------------------------------------------
Fax | 562-991-1581
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 18339
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 18339
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------