Healthcare Provider Details

I. General information

NPI: 1356695738
Provider Name (Legal Business Name): ROSSANA CATALINA BLACKBURN CDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 04/08/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14515 HAMLIN ST
VAN NUYS CA
91411-1608
US

IV. Provider business mailing address

14515 HAMLIN ST
VAN NUYS CA
91411-1608
US

V. Phone/Fax

Practice location:
  • Phone: 818-285-1900
  • Fax: 818-285-1906
Mailing address:
  • Phone: 818-285-1900
  • Fax: 818-285-1906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAII053250318
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: