Healthcare Provider Details

I. General information

NPI: 1467033498
Provider Name (Legal Business Name): PEARL KALILLA CAROSELLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date: 03/17/2026
Reactivation Date: 04/08/2026

III. Provider practice location address

9846 WHITE OAK AVE
NORTHRIDGE CA
91325-4806
US

IV. Provider business mailing address

9846 WHITE OAK AVE
NORTHRIDGE CA
91325-4806
US

V. Phone/Fax

Practice location:
  • Phone: 877-810-2230
  • Fax:
Mailing address:
  • Phone: 877-810-2230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberA154388
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: