Healthcare Provider Details

I. General information

NPI: 1568132157
Provider Name (Legal Business Name): GIOVANNI ELIJAH VELA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 E WASHINGTON BLVD STE 230
PASADENA CA
91107-1449
US

IV. Provider business mailing address

9808 VENICE BLVD STE 700
CULVER CITY CA
90232-6824
US

V. Phone/Fax

Practice location:
  • Phone: 626-296-8900
  • Fax:
Mailing address:
  • Phone: 310-945-3350
  • Fax: 310-945-3356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number144178
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: