Provider Demographics
NPI:1174607667
Name:OLSON, ROBERT A (CRNA, MS)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:A
Last Name:OLSON
Suffix:
Gender:M
Credentials:CRNA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7254 HOLLYWOOD BLVD APT 4
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-3117
Mailing Address - Country:US
Mailing Address - Phone:323-876-7934
Mailing Address - Fax:323-876-7934
Practice Address - Street 1:450 N ROXBURY DR
Practice Address - Street 2:SUITE 600
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4232
Practice Address - Country:US
Practice Address - Phone:310-651-2280
Practice Address - Fax:310-651-2260
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3404367500000X
OR200960007CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered