Basic Information
Provider Information
NPI: 1134289655
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BLEUEL
FirstName: OLGA
MiddleName: L
NamePrefix: DR.
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1040 FLYNN RD
Address2:  
City: CAMARILLO
State: CA
PostalCode: 930125092
CountryCode: US
TelephoneNumber: 8056733930
FaxNumber: 8056593217
Practice Location
Address1: 200 S WELLS RD STE 225
Address2:  
City: VENTURA
State: CA
PostalCode: 930041382
CountryCode: US
TelephoneNumber: 8056590560
FaxNumber: 8056599275
Other Information
ProviderEnumerationDate: 12/12/2006
LastUpdateDate: 06/09/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/09/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000X52713CAY Dental ProvidersDentist 

No ID Information.


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