Healthcare Provider Details

I. General information

NPI: 1710011580
Provider Name (Legal Business Name): IVANOE CELESTINE BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10155 COLIMA RD
WHITTIER CA
90603-2063
US

IV. Provider business mailing address

635 N CHIPPEWA AVE APT 7
ANAHEIM CA
92801-4431
US

V. Phone/Fax

Practice location:
  • Phone: 562-692-0383
  • Fax: 562-692-0380
Mailing address:
  • Phone: 562-692-0383
  • Fax: 562-692-0380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: