Basic Information
| Provider Information | |||||||||
| NPI: | 1902217425 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OLIVA | ||||||||
| FirstName: | FLORA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 GRAND AVE | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | SOUTH SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940803606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6502441444 | ||||||||
| FaxNumber: | 6502441447 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 GRAND AVE | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | SOUTH SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940803606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6502441444 | ||||||||
| FaxNumber: | 6502441447 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2014 | ||||||||
| LastUpdateDate: | 05/19/2014 | ||||||||
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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 | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | AD418603 | 01 | CA | ENTRE FAMILIA ODF | OTHER | 97037 | 01 | CA | CASA OLLIN | OTHER | AD414903 | 01 | CA | ENTRE FAMILIA IOP | OTHER |