Provider Demographics
NPI:1417582313
Name:KOTANJIAN, CELINA MARIA (NP-C)
Entity Type:Individual
Prefix:
First Name:CELINA
Middle Name:MARIA
Last Name:KOTANJIAN
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11822 FLORAL DR
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-2900
Mailing Address - Country:US
Mailing Address - Phone:562-908-4355
Mailing Address - Fax:
Practice Address - Street 1:11822 FLORAL DR
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601-2900
Practice Address - Country:US
Practice Address - Phone:562-908-4355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF02200050363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily