Provider Demographics
NPI:1093564544
Name:OLIVAS, DENNISE
Entity type:Individual
Prefix:
First Name:DENNISE
Middle Name:
Last Name:OLIVAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3015
Mailing Address - Street 2:
Mailing Address - City:MECCA
Mailing Address - State:CA
Mailing Address - Zip Code:92254-8015
Mailing Address - Country:US
Mailing Address - Phone:760-620-8789
Mailing Address - Fax:
Practice Address - Street 1:90125 70TH AVE SPC 4
Practice Address - Street 2:
Practice Address - City:MECCA
Practice Address - State:CA
Practice Address - Zip Code:92254-4511
Practice Address - Country:US
Practice Address - Phone:760-620-8789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician