Healthcare Provider Details

I. General information

NPI: 1952404451
Provider Name (Legal Business Name): VERA D CECILIO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16661 VENTURA BLVD STE 405
ENCINO CA
91436-1960
US

IV. Provider business mailing address

7345 MEDICAL CENTER DR STE 510
WEST HILLS CA
91307-1967
US

V. Phone/Fax

Practice location:
  • Phone: 818-986-1200
  • Fax: 818-986-3011
Mailing address:
  • Phone: 818-888-7878
  • Fax: 818-888-5200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberA26195
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: