Provider Demographics
NPI:1780820548
Name:OLSON, MITCHEL JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHEL
Middle Name:JAMES
Last Name:OLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 WRIGHT PL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-6583
Mailing Address - Country:US
Mailing Address - Phone:760-634-6755
Mailing Address - Fax:
Practice Address - Street 1:1902 WRIGHT PL
Practice Address - Street 2:SUITE 200
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-6583
Practice Address - Country:US
Practice Address - Phone:760-634-6755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65684208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice