Healthcare Provider Details

I. General information

NPI: 1619777927
Provider Name (Legal Business Name): ELIANA SILVIA GONCUIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25450 PRADO DE LAS PERAS
CALABASAS CA
91302-3656
US

IV. Provider business mailing address

25450 PRADO DE LAS PERAS
CALABASAS CA
91302-3656
US

V. Phone/Fax

Practice location:
  • Phone: 818-397-9615
  • Fax:
Mailing address:
  • Phone: 818-397-9615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number32644
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: