Provider Demographics
NPI:1477559979
Name:MEDHAT, OLA M (DO)
Entity Type:Individual
Prefix:
First Name:OLA
Middle Name:M
Last Name:MEDHAT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21323 VELETA CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-5326
Mailing Address - Country:US
Mailing Address - Phone:949-275-4548
Mailing Address - Fax:949-275-4548
Practice Address - Street 1:412 OLIVE AVE
Practice Address - Street 2:# 140
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-5142
Practice Address - Country:US
Practice Address - Phone:949-275-4548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6575207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG22498Medicare UPIN
CAW20A6575BMedicare ID - Type Unspecified