Provider Demographics
NPI:1831118710
Name:GARCIA-DERSCH, OLIVIA VALENTINA (MD)
Entity Type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:VALENTINA
Last Name:GARCIA-DERSCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:OLIVIA
Other - Middle Name:VALENTINA
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1818 MOORE BLVD #230
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-7687
Mailing Address - Country:US
Mailing Address - Phone:916-442-1011
Mailing Address - Fax:
Practice Address - Street 1:2000 O ST STE 210B
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-5286
Practice Address - Country:US
Practice Address - Phone:916-442-1011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA084219207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI42782Medicare UPIN
CA00A842190Medicare PIN