Provider Demographics
NPI:1841306743
Name:OLEVSKY, OLGA M (MD)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:M
Last Name:OLEVSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD SUITE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-5631
Mailing Address - Country:US
Mailing Address - Phone:310-301-8707
Mailing Address - Fax:
Practice Address - Street 1:2020 SANTA MONICA BLVD STE 230
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2124
Practice Address - Country:US
Practice Address - Phone:310-829-5471
Practice Address - Fax:310-582-7946
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67979207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A679790Medicaid
CAA67979OtherMEDICAL LICENSE
CAW15185AOtherMEDICARE PTAN - FACILITY
CAW15185OtherMEDICARE PTAN - FACILITY
CA00A679790Medicaid
CA00A679790Medicaid
CAW15185AOtherMEDICARE PTAN - FACILITY
CAW15185OtherMEDICARE PTAN - FACILITY
CAWA67979BMedicare PIN