Provider Demographics
NPI:1457480410
Name:EAGLIN, OLGA FRANKLIN
Entity Type:Individual
Prefix:MS
First Name:OLGA
Middle Name:FRANKLIN
Last Name:EAGLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2023 VALE RD STE 107
Mailing Address - Street 2:BROOKSIDE COMMUNITY HEALTH CENTER
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3891
Mailing Address - Country:US
Mailing Address - Phone:510-215-5001
Mailing Address - Fax:510-215-1115
Practice Address - Street 1:2023 VALE RD STE 107
Practice Address - Street 2:BROOKSIDE COMMUNITY HEALTH CENTER
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3891
Practice Address - Country:US
Practice Address - Phone:510-215-5001
Practice Address - Fax:510-215-1115
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13833363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant