Healthcare Provider Details

I. General information

NPI: 1689717027
Provider Name (Legal Business Name): CELINA MARCIANO PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 RAMONA BLVD STE E
IRWINDALE CA
91706-3752
US

IV. Provider business mailing address

17621 ORNA DR
GRANADA HILLS CA
91344-1331
US

V. Phone/Fax

Practice location:
  • Phone: 626-480-8107
  • Fax:
Mailing address:
  • Phone: 818-388-0102
  • Fax: 818-491-9215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number42997
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: