Provider Demographics
NPI:1710326244
Name:TAN, OLIVIA CAMPBELL (MS, CGC)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:CAMPBELL
Last Name:TAN
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 BEVERLY BLVD
Mailing Address - Street 2:SAMUEL OSCHIN COMPREHENSEIVE CANCER INSTITUTE, AC1177
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048
Mailing Address - Country:US
Mailing Address - Phone:310-423-7786
Mailing Address - Fax:310-423-9946
Practice Address - Street 1:8700 BEVERLY BLVD
Practice Address - Street 2:SAMUEL OSCHIN COMPREHENSEIVE CANCER INSTITUTE, AC1177
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048
Practice Address - Country:US
Practice Address - Phone:310-423-7786
Practice Address - Fax:310-423-9946
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC000817170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS