MEDICARE: MR. ABRAHAM OLAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1124341391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ABRAHAM OLAN

Provider Business Mailing Address
First Line	:	2715 N BROADWAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90031-2609
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2715 N BROADWAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90031-2609
Country	:	US
Telephone Number	:	323-756-9933
Fax Number	:	323-756-9515

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2010
Last Update Date	:	03/02/2010

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