Healthcare Provider Details

I. General information

NPI: 1083102263
Provider Name (Legal Business Name): ROSEMARY CELIS COBARRUBIAS CADC-CAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROSEMARY CELIS COBARRUBIAS C23011214

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 BEVERLY BLVD
LOS ANGELES CA
90057-2220
US

IV. Provider business mailing address

2330 BEVERLY BLVD
LOS ANGELES CA
90057-2220
US

V. Phone/Fax

Practice location:
  • Phone: 213-744-0724
  • Fax: 213-342-8078
Mailing address:
  • Phone: 213-744-0724
  • Fax: 213-342-8078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC23011214
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: