Provider Demographics
NPI:1063770204
Name:BANTIGUE, OLGA JANE C (RN)
Entity type:Individual
Prefix:MRS
First Name:OLGA JANE
Middle Name:C
Last Name:BANTIGUE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:JANE
Other - Middle Name:C
Other - Last Name:BANTIGUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:12238 EVEREST STREET
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650
Mailing Address - Country:US
Mailing Address - Phone:562-484-3023
Mailing Address - Fax:
Practice Address - Street 1:12238 EVEREST ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-2030
Practice Address - Country:US
Practice Address - Phone:562-484-3023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA615693163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health