Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 225400000X | Rehabilitation Practitioner |
NPI | 1043338049 |
---|---|
Provider Name | Mrs. Maria Olvera |
First Address | Los Angeles, CA 90005-1831 |
Second Address | Los Angeles, CA 90005-1831 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 17/09/2008 |