Provider Demographics
NPI:1437871324
Name:KEKEJIAN, CARLA RITA (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:RITA
Last Name:KEKEJIAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:964 CALLE DEL PACIFICO
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-3020
Mailing Address - Country:US
Mailing Address - Phone:818-399-3159
Mailing Address - Fax:
Practice Address - Street 1:964 CALLE DEL PACIFICO
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-3020
Practice Address - Country:US
Practice Address - Phone:818-399-3159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32512235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist