Provider Demographics
NPI:1063848760
Name:OLAGUE, LORENA
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:
Last Name:OLAGUE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LORENA
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:122 N FENIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-3920
Mailing Address - Country:US
Mailing Address - Phone:626-485-9951
Mailing Address - Fax:
Practice Address - Street 1:122 N FENIMORE AVE
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-3920
Practice Address - Country:US
Practice Address - Phone:626-485-9951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347151041C0700X
CA814401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical