Healthcare Provider Details

I. General information

NPI: 1437472271
Provider Name (Legal Business Name): MISS CELINE ANNETTE OGHOUBIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2010
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 MANHATTAN AVE
LA CRESCENTA CA
91214-3834
US

IV. Provider business mailing address

2905 MANHATTAN AVE
LA CRESCENTA CA
91214-3834
US

V. Phone/Fax

Practice location:
  • Phone: 818-216-5007
  • Fax:
Mailing address:
  • Phone: 818-216-5007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: