Doctor Name: | DR. MITCHEL JAMES OLSON |
NPI Number: | 1780820548 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | G65684 |
Business Practice Address: | 1902 Wright Pl Suite 200 Carlsbad, CA - 920086583 |
Business Phone Number: | 7606346755 |
Business Fax Number: | |
Mailing Address: | 1902 Wright Pl, Suite 200 CARLSBAD |
State: | CA |
Postal Code: | 920086583 |
Phone Number: | 7606346755 |
Fax Number: | |
NPI Enumeration Date: | 12/29/2008 |
NPI Last Update Date: | 12/29/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | G65684 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |