MEDICARE: CELENE CARRARA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula

General Provider Information

NPI Number	:	1174168801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CELENE CARRARA

Provider Business Mailing Address
First Line	:	1232 MONCADO DR
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91207-1830
Country	:	US
Telephone Number	:	818-298-4117
Fax Number	:

Provider Business Practice Location Address
First Line	:	1232 MONCADO DR
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91207-1830
Country	:	US
Telephone Number	:	818-298-4117
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2019
Last Update Date	:	12/23/2019

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Directions to “ CELENE CARRARA ” Practice Location

Language	Start Address	Practice Location

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