Healthcare Provider Details

I. General information

NPI: 1417582313
Provider Name (Legal Business Name): CELINA MARIA KOTANJIAN NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11822 FLORAL DR
WHITTIER CA
90601-2900
US

IV. Provider business mailing address

11822 FLORAL DR
WHITTIER CA
90601-2900
US

V. Phone/Fax

Practice location:
  • Phone: 562-908-4355
  • Fax:
Mailing address:
  • Phone: 562-908-4355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF02200050
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: