Provider Demographics
NPI:1124209184
Name:QUIJADA, OLIVIA
Entity Type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:
Last Name:QUIJADA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:OLIVIA
Other - Middle Name:
Other - Last Name:OCHOA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4176 INGLEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-5250
Mailing Address - Country:US
Mailing Address - Phone:310-751-1195
Mailing Address - Fax:323-291-5007
Practice Address - Street 1:4176 INGLEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-5250
Practice Address - Country:US
Practice Address - Phone:310-751-1195
Practice Address - Fax:323-291-5007
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CAAPCC5146101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator