Provider Demographics
NPI:1992517924
Name:KNOWLES, OLIVIA MARY (LM)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:MARY
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 BROADWAY APT 115
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-4910
Mailing Address - Country:US
Mailing Address - Phone:303-748-4221
Mailing Address - Fax:
Practice Address - Street 1:555 W COUNTRY CLUB LN STE H
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-1226
Practice Address - Country:US
Practice Address - Phone:760-990-0675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA758176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife