Provider Demographics
NPI:1225563083
Name:KORELOVA, OLGA VALERIEVNA (MD)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:VALERIEVNA
Last Name:KORELOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1417
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067-1417
Mailing Address - Country:US
Mailing Address - Phone:858-386-0549
Mailing Address - Fax:858-327-3499
Practice Address - Street 1:9320 CARMEL MOUNTAIN RD STE D
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-2159
Practice Address - Country:US
Practice Address - Phone:858-386-0549
Practice Address - Fax:877-371-4726
Is Sole Proprietor?:No
Enumeration Date:2017-04-28
Last Update Date:2022-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1640052084P0800X
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program