Provider Demographics
NPI:1346939600
Name:OLIVA, CHRISTOPHER EMRALINO (SUDRC)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:EMRALINO
Last Name:OLIVA
Suffix:
Gender:M
Credentials:SUDRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3675 HUNTINGTON DR STE 101
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-5645
Mailing Address - Country:US
Mailing Address - Phone:626-314-2818
Mailing Address - Fax:
Practice Address - Street 1:3675 HUNTINGTON DR STE 101
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-5645
Practice Address - Country:US
Practice Address - Phone:626-314-2818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15561101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)