Provider Demographics
NPI:1740833912
Name:OLIDEN CORTEZ, JONATHAN ALFREDO (BS)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ALFREDO
Last Name:OLIDEN CORTEZ
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:JONATHAN
Other - Middle Name:ALFREDO
Other - Last Name:OLIDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS
Mailing Address - Street 1:10205 SAMOA AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-3538
Mailing Address - Country:US
Mailing Address - Phone:818-293-9783
Mailing Address - Fax:
Practice Address - Street 1:1020 S ARROYO PKWY STE 200
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3912
Practice Address - Country:US
Practice Address - Phone:626-403-2794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator