Healthcare Provider Details

I. General information

NPI: 1689285900
Provider Name (Legal Business Name): CELINA CAOVAN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1294 W 6TH ST STE 101
SAN PEDRO CA
90731-2997
US

IV. Provider business mailing address

1294 W 6TH ST STE 101
SAN PEDRO CA
90731-2997
US

V. Phone/Fax

Practice location:
  • Phone: 310-547-1850
  • Fax:
Mailing address:
  • Phone: 310-547-1850
  • Fax: 310-547-1972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number298688
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: