Provider Demographics
NPI:1164032579
Name:DEVITT, OLGA (LVN)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:DEVITT
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25214 CLEMENS LN
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-4103
Mailing Address - Country:US
Mailing Address - Phone:949-395-4877
Mailing Address - Fax:
Practice Address - Street 1:2000 CORPORATE DR APT 901
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-1118
Practice Address - Country:US
Practice Address - Phone:949-429-9713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-01
Last Update Date:2020-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA181256164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB7322796OtherDRIVERS LICENSE