Individual
LEISA ANGELINA OLIVIERI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
891 MOUNTAIN RANCH RD, SAN ANDREAS, CA 95249-9713
(209) 768-1464
Mailing address
P.O. BOX 62, SAN ANDREAS, CA 95249
(209) 768-1464
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
690209
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
94-600-507
—
CA
Enumeration date
09/16/2009
Last updated
12/11/2013
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