Provider Demographics
NPI:1598302978
Name:OLSON, AVELINA FLORES
Entity type:Individual
Prefix:
First Name:AVELINA
Middle Name:FLORES
Last Name:OLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19009 SHERMAN WAY UNIT 81
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-7711
Mailing Address - Country:US
Mailing Address - Phone:818-390-5146
Mailing Address - Fax:
Practice Address - Street 1:12831 MACLAY ST
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-4934
Practice Address - Country:US
Practice Address - Phone:818-361-4455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4185224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant