Provider Demographics
NPI:1932696853
Name:REEDER, OLIVIA MONICA (LVN)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:MONICA
Last Name:REEDER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:
Other - Last Name:CERVANTES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8281 AVENIDA LEON
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3410
Mailing Address - Country:US
Mailing Address - Phone:626-377-1978
Mailing Address - Fax:
Practice Address - Street 1:8281 AVENIDA LEON
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3410
Practice Address - Country:US
Practice Address - Phone:626-377-1978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN237509164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse