Provider Demographics
NPI:1033667662
Name:WITRAGO, OLGA
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:WITRAGO
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 1:701 W CERSAR CHAVEZ SUITE 201
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012
Mailing Address - Country:US
Mailing Address - Phone:213-217-5300
Mailing Address - Fax:213-217-5350
Practice Address - Street 1:701 W CERSAR CHAVEZ SUITE 201
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012
Practice Address - Country:US
Practice Address - Phone:213-217-5300
Practice Address - Fax:213-217-5350
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN574254171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator