Provider Demographics
NPI:1942342001
Name:OLENICK, STANLEY SPENCER (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:SPENCER
Last Name:OLENICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 E WILLOW ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2703
Mailing Address - Country:US
Mailing Address - Phone:562-427-7486
Mailing Address - Fax:562-595-7262
Practice Address - Street 1:790 EAST WILLOW ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2703
Practice Address - Country:US
Practice Address - Phone:562-427-7486
Practice Address - Fax:562-595-7262
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC37717207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C377170OtherMEDI-CAL
CAA36739Medicare UPIN
CAC37717Medicare ID - Type Unspecified