Healthcare Provider Details

I. General information

NPI: 1851688527
Provider Name (Legal Business Name): KARLA NATALY AGNEW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7232 CANBY AVE STE 6
RESEDA CA
91335-8141
US

IV. Provider business mailing address

4544 SAN FERNANDO RD STE 202
GLENDALE CA
91204-5015
US

V. Phone/Fax

Practice location:
  • Phone: 818-705-5561
  • Fax:
Mailing address:
  • Phone: 818-240-8843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: