1215191531 NPI number — DAVID ANTHONY OLENIK M.D.

Table of content: DAVID ANTHONY OLENIK M.D. (NPI 1215191531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215191531 NPI number — DAVID ANTHONY OLENIK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLENIK
Provider First Name:
DAVID
Provider Middle Name:
ANTHONY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215191531
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 9TH ST
Provider Second Line Business Mailing Address:
ROOM 205 MAIL STOP 2-3
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95814-6414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-654-2431
Provider Business Mailing Address Fax Number:
916-654-3186

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24511 WEST JAYNE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COALINGA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93210-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-935-4301
Provider Business Practice Location Address Fax Number:
559-935-7118
Provider Enumeration Date:
07/16/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084F0202X , with the licence number:  C33270 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084F0202X , with the licence number: 16287 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)