Provider Demographics
NPI:1982741898
Name:OLEA, JOHN G (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:G
Last Name:OLEA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5486
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-5486
Mailing Address - Country:US
Mailing Address - Phone:818-550-0900
Mailing Address - Fax:505-293-1524
Practice Address - Street 1:1141 N BRAND BLVD
Practice Address - Street 2:STE 200
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2511
Practice Address - Country:US
Practice Address - Phone:818-550-0900
Practice Address - Fax:505-293-1524
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA48729207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A487290Medicaid
CA00A487290Medicaid
CAA48729AMedicare Oscar/Certification