Basic Information
| Provider Information | |||||||||
| NPI: | 1003349135 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | OLVEDA | ||||||||
| FirstName: | REBECCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 16TH ST | ||||||||
| Address2: | 4TH FLOOR, 4551, BOX 0110 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941432549 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 550 16TH ST | ||||||||
| Address2: | 4TH FLOOR, 4551, BOX 0110 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941432549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154766245 | ||||||||
| FaxNumber: | 4154765354 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2017 | ||||||||
| LastUpdateDate: | 05/02/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 161557 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.