MEDICARE: OLIVIA JANAE PARKS

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1275319071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA JANAE PARKS

Provider Business Mailing Address
First Line	:	1901 CEDAR AVE APT 1
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-5339
Country	:	US
Telephone Number	:	562-477-1908
Fax Number	:

Provider Business Practice Location Address
First Line	:	1901 CEDAR AVE APT 1
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-5339
Country	:	US
Telephone Number	:	562-477-1908
Fax Number	:

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

Provider Enumeration Date	:	09/06/2023
Last Update Date	:	09/06/2023

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Directions to “ OLIVIA JANAE PARKS ” Practice Location

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