Provider Demographics
NPI:1649906819
Name:OLSEN, MARCUS (PA-C)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:OLSEN
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9301 WILSHIRE BLVD STE 506
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-6189
Mailing Address - Country:US
Mailing Address - Phone:424-239-5981
Mailing Address - Fax:
Practice Address - Street 1:2039 FOREST AVE STE 201
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4815
Practice Address - Country:US
Practice Address - Phone:408-358-8090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)