Provider Demographics
NPI:1114509395
Name:OLMEDO, BEATRIZ AURORA
Entity Type:Individual
Prefix:MS
First Name:BEATRIZ
Middle Name:AURORA
Last Name:OLMEDO
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 1:1050 20TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-3155
Mailing Address - Country:US
Mailing Address - Phone:916-307-6100
Mailing Address - Fax:
Practice Address - Street 1:8401 CENTER PKWY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5704
Practice Address - Country:US
Practice Address - Phone:530-650-2711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANBC-220812083S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine