Basic Information
| Provider Information | |||||||||
| NPI: | 1487920294 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OLIVA | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | ANDREW | ||||||||
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| Credential: | BA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1122 E 65TH ST | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908052404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622341512 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2939 E PACIFIC COMMERCE DR | ||||||||
| Address2: | |||||||||
| City: | COMPTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902215729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106310793 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2012 | ||||||||
| LastUpdateDate: | 06/14/2013 | ||||||||
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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 | 225400000X | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.