Provider Demographics
NPI:1093054173
Name:OLIVERA, DARRETTE MARIE (RN, BSN, PHN,INP)
Entity Type:Individual
Prefix:MS
First Name:DARRETTE
Middle Name:MARIE
Last Name:OLIVERA
Suffix:
Gender:F
Credentials:RN, BSN, PHN,INP
Other - Prefix:MS
Other - First Name:DORETTE
Other - Middle Name:MARIE
Other - Last Name:OLIVERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN,BSN,PHN,INP
Mailing Address - Street 1:22330 MEYLER ST
Mailing Address - Street 2:#7
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502
Mailing Address - Country:US
Mailing Address - Phone:310-968-7874
Mailing Address - Fax:
Practice Address - Street 1:22330 MEYLER ST #7
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502
Practice Address - Country:US
Practice Address - Phone:310-968-7874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-08
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA509658163WC0400X, 163WH0200X, 163WP0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WP0200XNursing Service ProvidersRegistered NursePediatrics