Healthcare Provider Details

I. General information

NPI: 1851770374
Provider Name (Legal Business Name): CELIA ALICIA AKOSSIWA ESSI YOVO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 05/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4821 BELAIR RD
BALTIMORE MD
21206-5731
US

IV. Provider business mailing address

4821 BELAIR RD
BALTIMORE MD
21206-5731
US

V. Phone/Fax

Practice location:
  • Phone: 443-722-1156
  • Fax:
Mailing address:
  • Phone: 443-722-1156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberA4275
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: