Healthcare Provider Details

I. General information

NPI: 1558677674
Provider Name (Legal Business Name): VERA D. CECILIO, M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2010
Last Update Date: 07/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 ETIWANDA AVE SUITE 322
TARZANA CA
91356-6119
US

IV. Provider business mailing address

5525 ETIWANDA AVE SUITE 322
TARZANA CA
91356-6119
US

V. Phone/Fax

Practice location:
  • Phone: 818-609-7200
  • Fax: 818-343-8869
Mailing address:
  • Phone: 818-609-7200
  • Fax: 818-343-8869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberA26195
License Number StateCA

VIII. Authorized Official

Name: DR. VERA D. CECILIO
Title or Position: OWNER
Credential: M.D.
Phone: 818-609-7200