MEDICARE: MR. CHRISTOPHER EMRALINO OLIVA SUDRC

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	15561	CA

General Provider Information

NPI Number	:	1346939600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER EMRALINO OLIVA SUDRC

Provider Business Mailing Address
First Line	:	3675 HUNTINGTON DR STE 101
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-5645
Country	:	US
Telephone Number	:	626-314-2818
Fax Number	:

Provider Business Practice Location Address
First Line	:	3675 HUNTINGTON DR STE 101
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-5645
Country	:	US
Telephone Number	:	626-314-2818
Fax Number	:

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

Provider Enumeration Date	:	05/03/2023
Last Update Date	:	12/30/2024

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