Provider Demographics
NPI:1639904337
Name:DE LA OLIVA, MAKAYLA SABRINA
Entity type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:SABRINA
Last Name:DE LA OLIVA
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 1:22641 E RIDGE TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-2699
Mailing Address - Country:US
Mailing Address - Phone:720-525-5691
Mailing Address - Fax:
Practice Address - Street 1:22641 E RIDGE TRAIL DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-2699
Practice Address - Country:US
Practice Address - Phone:720-525-5691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician