Provider Demographics
NPI:1821181553
Name:OLMECAH, HUITZILIN M (MD)
Entity Type:Individual
Prefix:
First Name:HUITZILIN
Middle Name:M
Last Name:OLMECAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11175 CAMPUS ST
Mailing Address - Street 2:DEPARTMENT OF NEUROLOGY, COLEMAN PAVILION - RM. 11108
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92350-1700
Mailing Address - Country:US
Mailing Address - Phone:909-558-4907
Mailing Address - Fax:909-558-0207
Practice Address - Street 1:11175 CAMPUS ST
Practice Address - Street 2:DEPARTMENT OF NEUROLOGY, COLEMAN PAVILION - RM. 11108
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92350-1700
Practice Address - Country:US
Practice Address - Phone:909-558-4907
Practice Address - Fax:909-558-0207
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94960207T00000X
NMMD2022-13642084N0400X
OH35.120019207T00000X
WI22784207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH134150Medicare PIN