Provider Demographics
NPI:1902638018
Name:OLIVEIRA, ELLEN Y
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:Y
Last Name:OLIVEIRA
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 1:4072 HURON AVE
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-4017
Mailing Address - Country:US
Mailing Address - Phone:408-829-9419
Mailing Address - Fax:
Practice Address - Street 1:4072 HURON AVE
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-4017
Practice Address - Country:US
Practice Address - Phone:408-829-9419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA729194163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse