Provider Demographics
NPI:1447454814
Name:OLMEDOCOLOR, PEDRO (PA-C)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:
Last Name:OLMEDOCOLOR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:PEDRO
Other - Middle Name:
Other - Last Name:OLMEDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3300 E SOUTH ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90805-4549
Mailing Address - Country:US
Mailing Address - Phone:562-622-8102
Mailing Address - Fax:562-622-6072
Practice Address - Street 1:3300 E SOUTH ST
Practice Address - Street 2:SUITE 305
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90805-4549
Practice Address - Country:US
Practice Address - Phone:562-622-8102
Practice Address - Fax:562-622-6072
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 19056363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant