Healthcare Provider Details

I. General information

NPI: 1043380298
Provider Name (Legal Business Name): MR. CESAR CARRENO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20151 NORDHOFF ST
CHATSWORTH CA
91311-6215
US

IV. Provider business mailing address

12001 FOOTHILL BLVD
LAKE VIEW TERRACE CA
91342-6402
US

V. Phone/Fax

Practice location:
  • Phone: 818-407-3200
  • Fax:
Mailing address:
  • Phone: 818-897-1622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: