Provider Demographics
NPI:1821477332
Name:OLIVARES, MONICA
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:OLIVARES
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 1:7033 MILTON AVE
Mailing Address - Street 2:G
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-1320
Mailing Address - Country:US
Mailing Address - Phone:562-479-6247
Mailing Address - Fax:
Practice Address - Street 1:942 S ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-4004
Practice Address - Country:US
Practice Address - Phone:323-263-9700
Practice Address - Fax:323-263-8042
Is Sole Proprietor?:No
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA019-23101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)