Provider Demographics
NPI:1487219978
Name:ACEVEDO, KARINA ISABELLA (BSW)
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:ISABELLA
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 RAYMOND AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-2814
Mailing Address - Country:US
Mailing Address - Phone:818-970-1345
Mailing Address - Fax:
Practice Address - Street 1:8215 VAN NUYS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4827
Practice Address - Country:US
Practice Address - Phone:818-855-2270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner