Provider Demographics
NPI:1376420026
Name:OLIVAR, JEMIMAH (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JEMIMAH
Middle Name:
Last Name:OLIVAR
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:JEMIMAH THERESA
Other - Middle Name:
Other - Last Name:OLIVAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:1625 SANTA VENETIA ST APT 13303
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-3180
Mailing Address - Country:US
Mailing Address - Phone:619-512-7749
Mailing Address - Fax:
Practice Address - Street 1:3930 4TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3119
Practice Address - Country:US
Practice Address - Phone:619-512-7749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-16
Last Update Date:2025-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95036121363LP0808X
CA95098572163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse