Provider Demographics
NPI:1578760435
Name:OLIVA, JUAN C (MS, MFT)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:C
Last Name:OLIVA
Suffix:
Gender:M
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6455 BEN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-1506
Mailing Address - Country:US
Mailing Address - Phone:323-634-3805
Mailing Address - Fax:323-634-3870
Practice Address - Street 1:6455 BEN AVE
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-1506
Practice Address - Country:US
Practice Address - Phone:323-634-3805
Practice Address - Fax:323-634-3870
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43563106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist