MEDICARE: DEANNA OLIVER MD

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	208M00000X	Hospitalist Physician	A139921	CA
2	207R00000X	Internal Medicine Physician	A139921	CA

General Provider Information

NPI Number	:	1750725362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANNA OLIVER MD

Provider Business Mailing Address
First Line	:	131 ORANGE AVE STE 101B
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92118-1408
Country	:	US
Telephone Number	:	619-522-0399
Fax Number	:

Provider Business Practice Location Address
First Line	:	131 ORANGE AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92118-1408
Country	:	US
Telephone Number	:	619-522-0399
Fax Number	:

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

Provider Enumeration Date	:	04/25/2013
Last Update Date	:	09/26/2022

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