Healthcare Provider Details

I. General information

NPI: 1790158889
Provider Name (Legal Business Name): STEPHANIE PABALAN ROLANDO BARELA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2015
Last Update Date: 11/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W CARSON ST
CARSON CA
90745-2601
US

IV. Provider business mailing address

150 W CARSON ST
CARSON CA
90745-2601
US

V. Phone/Fax

Practice location:
  • Phone: 310-549-6500
  • Fax:
Mailing address:
  • Phone: 310-549-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number67883
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: