Provider Demographics
NPI:1790334654
Name:OLEA, JUSTINA ALFARO
Entity Type:Individual
Prefix:
First Name:JUSTINA
Middle Name:ALFARO
Last Name:OLEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9617 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-2228
Mailing Address - Country:US
Mailing Address - Phone:916-895-5023
Mailing Address - Fax:
Practice Address - Street 1:9701 DINO DR STE 170
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-4042
Practice Address - Country:US
Practice Address - Phone:916-892-0013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst