Provider Demographics
NPI:1558956615
Name:CAMPOS OLVERA, PAULA DELFINA
Entity type:Individual
Prefix:MISS
First Name:PAULA
Middle Name:DELFINA
Last Name:CAMPOS OLVERA
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 1:3369 E TOWNSEND AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93702-4162
Mailing Address - Country:US
Mailing Address - Phone:559-612-0140
Mailing Address - Fax:
Practice Address - Street 1:3103 E CARTWRIGHT AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93725-9385
Practice Address - Country:US
Practice Address - Phone:559-498-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA694963172V00000X, 164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No172V00000XOther Service ProvidersCommunity Health Worker