Provider Demographics
NPI:1952016073
Name:OLSON, INEZ (PA-C, RRT)
Entity Type:Individual
Prefix:MS
First Name:INEZ
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:PA-C, RRT
Other - Prefix:
Other - First Name:INEZ
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PA PROGRAM 1730 E. 120TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059
Mailing Address - Country:US
Mailing Address - Phone:909-732-1090
Mailing Address - Fax:
Practice Address - Street 1:PA PROGRAM 1730 E. 120TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059
Practice Address - Country:US
Practice Address - Phone:909-732-1090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000000000Medicaid