=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912744269
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROSE ELIA CHAHLA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2024
-----------------------------------------------------
Last Update Date | 07/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8335 W SUNSET BLVD STE 248
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90069-1556
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-925-1262
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2930 DOMINGO AVE # 1054
-----------------------------------------------------
City | BERKELEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94705-2454
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-442-4051
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 13889
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------