Healthcare Provider Details

I. General information

NPI: 1144934613
Provider Name (Legal Business Name): KAREN ISELA ARAGON PRUDENCIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2023
Last Update Date: 01/10/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 W DRYDEN ST
GLENDALE CA
91202-3748
US

IV. Provider business mailing address

11465 RUGGIERO AVE
SYLMAR CA
91342-6737
US

V. Phone/Fax

Practice location:
  • Phone: 323-303-2588
  • Fax:
Mailing address:
  • Phone: 323-303-2588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: