Healthcare Provider Details

I. General information

NPI: 1982939344
Provider Name (Legal Business Name): CLAUDIA COELLO M.A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2009
Last Update Date: 01/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6305 WOODMAN AVE
VAN NUYS CA
91401-2346
US

IV. Provider business mailing address

6305 WOODMAN AVE
VAN NUYS CA
91401-2346
US

V. Phone/Fax

Practice location:
  • Phone: 818-898-0223
  • Fax:
Mailing address:
  • Phone: 818-901-6376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMF64182
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberIMF64182
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: