Provider Demographics
NPI:1558542076
Name:GLORIA DE OLARTE M.D. INC.
Entity Type:Organization
Organization Name:GLORIA DE OLARTE M.D. INC.
Other - Org Name:GLORIA DE OLARTE M.D. INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE OLARTE
Authorized Official - Suffix:I
Authorized Official - Credentials:DOCTOR
Authorized Official - Phone:626-577-7965
Mailing Address - Street 1:65 N.MADISON AVENUE
Mailing Address - Street 2:SUITE 406
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101
Mailing Address - Country:US
Mailing Address - Phone:626-577-7965
Mailing Address - Fax:
Practice Address - Street 1:65 N.MADISON AVENUE
Practice Address - Street 2:SUITE 406
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101
Practice Address - Country:US
Practice Address - Phone:626-577-7965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35537261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1457436685OtherNPI