Provider Demographics
NPI:1093973752
Name:BOCANEGRA, OLIVIA HAVARD (MD)
Entity Type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:HAVARD
Last Name:BOCANEGRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:OLIVIA
Other - Middle Name:HAVARD
Other - Last Name:BOCANEGRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1650 RESPONSE RD
Mailing Address - Street 2:KAISER PERMANENTE
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1650 RESPONSE RD
Practice Address - Street 2:KAISER PERMANENTE
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4807
Practice Address - Country:US
Practice Address - Phone:916-614-4823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA107079208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics