Active NPI
Heather Larae Olmos
- Child Mental Illness Respite Care
- Sierra Vista, AZ
National Provider Identifier
1629220462
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child Mental Illness Respite Care
- License
- 11412
- Practice address
- 2733 Quail Run Dr
Sierra Vista, AZ 85635-3448 - Phone
- (520) 459-2371
- NPI assigned
- Oct 10, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Child Mental Illness Respite Care | 385HR2055X | 11412 | AZ | Primary |
Addresses
Primary practice location
2733 Quail Run Dr
Sierra Vista, AZ 85635-3448
Mailing address
2733 Quail Run Dr
Sierra Vista, AZ 85635-3448
Phone (520) 459-2371
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00000000 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11412 | AZ | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1223596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1223596800000",
"number": "1629220462",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2733 QUAIL RUN DR",
"city": "SIERRA VISTA",
"state": "AZ",
"postal_code": "856353448",
"telephone_number": "520-459-2371"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2733 QUAIL RUN DR",
"city": "SIERRA VISTA",
"state": "AZ",
"postal_code": "856353448",
"telephone_number": "520-459-2371"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLMOS",
"first_name": "HEATHER",
"middle_name": "LARAE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-10-10",
"last_updated": "2008-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "385HR2055X",
"taxonomy_group": "",
"desc": "Respite Care, Respite Care, Mental Illness, Child",
"state": "AZ",
"license": "11412",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00000000",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sierra Vista, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.