Provider Demographics
NPI:1518018183
Name:COLACION OLSON, LORRAINE ANNA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:ANNA
Last Name:COLACION OLSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11671 NORGROVE LN
Mailing Address - Street 2:
Mailing Address - City:ROSSMOOR
Mailing Address - State:CA
Mailing Address - Zip Code:90720-4025
Mailing Address - Country:US
Mailing Address - Phone:562-596-1004
Mailing Address - Fax:
Practice Address - Street 1:25965 NORMANDIE AVE
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-3416
Practice Address - Country:US
Practice Address - Phone:310-517-4417
Practice Address - Fax:310-517-4103
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11444363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical