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NPI Code Detail

MEDICARE: MS. ESMERALDA OLIVARES M.S., PPS

MEDICARE: MS. ESMERALDA OLIVARES M.S., PPS
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
1103TS0200XSchool Psychologist
2106H00000XMarriage & Family TherapistIMF67650CA

General Provider Information

NPI Number : 1720118557
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ESMERALDA OLIVARES M.S., PPS
Provider Business Mailing Address
First Line : 1721 GRIFFIN AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90031-3312
Country : US
Telephone Number : 323-221-4134
Fax Number : 323-221-4231
Provider Business Practice Location Address
First Line : 1721 GRIFFIN AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90031-3312
Country : US
Telephone Number : 323-221-4134
Fax Number : 323-221-4231
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2007
Last Update Date : 10/25/2024

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