| Olive Tree Wellness Center, Inc | |
|
1146 Olivewood Dr Merced CA 95348-1210 | |
| (209) 723-0019 | |
| (415) 946-3489 |
| Full Name | Olive Tree Wellness Center, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 1146 Olivewood Dr, Merced, California |
| Authorized Official Name and Position | Pamela Roussos (OWNER) |
| Authorized Official Contact | 2097230019 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Olive Tree Wellness Center, Inc Po Box 2718 Merced CA 95344-0718 Ph: (209) 723-0019 | Olive Tree Wellness Center, Inc 1146 Olivewood Dr Merced CA 95348-1210 Ph: (209) 723-0019 |
| NPI Number | 1295997419 |
|---|---|
| Provider Enumeration Date | 06/29/2008 |
| Last Update Date | 04/02/2012 |
| Medicare PECOS PAC ID | 5496894230 |
|---|---|
| Medicare Enrollment ID | O20091208000190 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295997419 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 20A8409 (California) | Primary |
| Provider Name | Pamela Roussos |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275612038 PECOS PAC ID: 2062461825 Enrollment ID: I20050119000376 |
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