Provider Demographics
NPI:1235796830
Name:OLIVA, CHRISTOPHER ARTURO (N/A)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ARTURO
Last Name:OLIVA
Suffix:
Gender:M
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:957 MENLO AVE APT 103
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2831
Mailing Address - Country:US
Mailing Address - Phone:213-519-2964
Mailing Address - Fax:
Practice Address - Street 1:4322 WILSHIRE BLVD STE 104
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3737
Practice Address - Country:US
Practice Address - Phone:323-879-4951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA97634130DOtherMEDI-CAL PROGRAM