Provider Demographics
NPI:1326255852
Name:OLAYA, JOFFRE ENRIQUE
Entity Type:Individual
Prefix:DR
First Name:JOFFRE
Middle Name:ENRIQUE
Last Name:OLAYA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 W LA VETA AVE STE 710
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4306
Mailing Address - Country:US
Mailing Address - Phone:714-835-2724
Mailing Address - Fax:714-835-2752
Practice Address - Street 1:1010 W LA VETA AVE STE 710
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4306
Practice Address - Country:US
Practice Address - Phone:714-835-2724
Practice Address - Fax:714-835-2752
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAMD60370239207T00000X
CAA104640207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program