Individual
JESSE M OLMEDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
14800 W MOUNTAIN VIEW BLVD, SUITE 160, SURPRISE, AZ 85374-2700
(623) 584-3376
(623) 584-3375
Mailing address
14800 W MOUNTAIN VIEW BLVD, SUITE 160, SURPRISE, AZ 85374-4795
(623) 584-3376
(623) 584-3375
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
30536
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1265490429
AHCCCS
AZ
01
—
188961600
DEPT OF LABOR WORK COMP
AZ
01
—
2281872
UNITED HEALTHCARE
AZ
01
—
2Z3349
HEALTH NET
AZ
01
—
7538647
AETNA
AZ
01
—
99S007000011
MEDISUN
AZ
01
—
AZ0779550
BLUE CROSS BLUE SHIELD
AZ
01
—
P00234871
RAILROAD MEDICARE
AZ
Enumeration date
05/03/2006
Last updated
04/09/2014
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