MEDICARE: OLIVIA M HUMPHREY

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	225700000X	Massage Therapist	93522	CA

General Provider Information

NPI Number	:	1629572540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA M HUMPHREY

Provider Business Mailing Address
First Line	:	2125 GOLD POPPY ST
Second Line	:
City	:	BRENTWOOD
State	:	CA
Zip	:	94513-1733
Country	:	US
Telephone Number	:	310-916-6926
Fax Number	:

Provider Business Practice Location Address
First Line	:	154 SANTA CLARA AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94610-1323
Country	:	US
Telephone Number	:	415-888-7949
Fax Number	:

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

Provider Enumeration Date	:	03/23/2018
Last Update Date	:	01/21/2026

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