Provider Demographics
NPI:1851096952
Name:VICUNA, OLGA (MSW)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:VICUNA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16415 HALLOW ROOT ST
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-5935
Mailing Address - Country:US
Mailing Address - Phone:909-275-1824
Mailing Address - Fax:
Practice Address - Street 1:16415 HALLOW ROOT ST
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-5935
Practice Address - Country:US
Practice Address - Phone:909-275-1824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor