Healthcare Provider Details

I. General information

NPI: 1235698432
Provider Name (Legal Business Name): KAREL-BART CELIE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 09/21/2023
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 MARENGO ST
LOS ANGELES CA
90033-1352
US

IV. Provider business mailing address

2051 MARENGO ST
LOS ANGELES CA
90033-1352
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-7903
  • Fax:
Mailing address:
  • Phone: 323-442-7903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA179171
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA179171
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: