Individual
HEATHER LARAE OLMOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2733 QUAIL RUN DR, SIERRA VISTA, AZ 85635-3448
(520) 459-2371
Mailing address
2733 QUAIL RUN DR, SIERRA VISTA, AZ 85635-3448
(520) 459-2371
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
11412
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000000
—
AZ
Enumeration date
10/10/2008
Last updated
10/10/2008
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