MEDICARE: CARLY OLES RD

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	133V00000X	Registered Dietitian		CA

General Provider Information

NPI Number	:	1962358010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLY OLES RD

Provider Business Mailing Address
First Line	:	741 PRINTZ RD
Second Line	:
City	:	ARROYO GRANDE
State	:	CA
Zip	:	93420-5023
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 E CHURCH ST
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93454-5906
Country	:	US
Telephone Number	:	805-739-3000
Fax Number	:

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

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/10/2026

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