Evelina A. Olson

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

License

08426593 Issued in CA

Practice address

1620 Swallow Way
Hercules, CA 94547-1648

Phone

(510) 915-0158

NPI assigned

Dec 2, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1638403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638403200000",
    "number": "1417615840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 SWALLOW WAY",
            "city": "HERCULES",
            "state": "CA",
            "postal_code": "945471648",
            "telephone_number": "510-915-0158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 SWALLOW WAY",
            "city": "HERCULES",
            "state": "CA",
            "postal_code": "945471648",
            "telephone_number": "510-915-0158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSON",
        "first_name": "EVELINA",
        "middle_name": "A.",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-02",
        "last_updated": "2021-12-02",
        "certification_date": "2021-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "CA",
            "license": "08426593",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVER'S LICENSE",
            "identifier": "E0701386",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• North Shore Dental LLC
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• Alison S Olivares Guzman
• Edna Opong-Mensah, RN
• Gerardo Ordonez Rodas
• Juliana Maria Orellana
• Manuella Orsi
• Norah Otieno

• Adult Medicine Physician in Hercules, CA
• Providers in Hercules, CA by specialty
• Adult Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.