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General NPI Number Information
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NPI Number | 1467746453
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Entity Type | Individual
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Provider Name | CELENE BARDALES MULHOLLAND M.D., MPH
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Gender | Female
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Dates
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Enumeration Date | 06/07/2011
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Last Update Date | 11/22/2021
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Provider Practice Location Address
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Address Line | 630 S RAYMOND AVE UNIT 330
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City | PASADENA
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State | CA
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Zip | 91105-3206
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Country | US
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Telephone | 626-793-8194
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Fax |
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Provider Business Mailing Address
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Address Line | 630 S RAYMOND AVE UNIT 330
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City | PASADENA
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State | CA
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Zip | 91105-3206
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Country | US
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Telephone | 626-793-8194
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Fax | 626-793-3664
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | R73519
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License Number State | AZ
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