Basic Information
| Provider Information | |||||||||
| NPI: | 1124386198 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OLSON | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | TAYLOR | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24615 RICHMAN DRIVE | ||||||||
| Address2: | |||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92354 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 11441 HEACOCK ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | MORENO VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925577907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512475809 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2012 | ||||||||
| LastUpdateDate: | 08/05/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A129976 | CA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208M00000X | A129976 | CA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | A129976 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.