Healthcare Provider Details

I. General information

NPI: 1114682770
Provider Name (Legal Business Name): CHELSEA CLEVELAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 W 190TH ST STE 250
GARDENA CA
90248-4305
US

IV. Provider business mailing address

996 ROYAL MARCO WAY
MARCO ISLAND FL
34145-1829
US

V. Phone/Fax

Practice location:
  • Phone: 310-878-3949
  • Fax:
Mailing address:
  • Phone: 818-345-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: