Provider Information for 1316977069
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Mr. MARTIN H. OLIVARES MFT, PH.D
Sex: Male
NPI: 1316977069
Last Updated: 2007-07-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1316977069 | ||||||||||||
| Enumeration Date | 2006-07-05 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 118 N HAYWORTH AVE APT. #1 LOS ANGELES, CA 90048-3631 United States Phone: 310-993-0557 | Fax:213-201-1392 | ||||||||||||
| Primary Practice Address | 152 S LASKY DR SUITE 208 BEVERLY HILLS, CA 90212-1720 United States Phone: 310-993-0557 | Fax:213-201-1392 | ||||||||||||
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