Provider Demographics
NPI:1326837147
Name:OLMEDO, BRYAN
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:OLMEDO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14632 YORBA ST STE B
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-2554
Mailing Address - Country:US
Mailing Address - Phone:714-714-0780
Mailing Address - Fax:
Practice Address - Street 1:14632 YORBA ST STE B
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2554
Practice Address - Country:US
Practice Address - Phone:714-714-0780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker