Provider Demographics
NPI:1689247959
Name:ALLI-CASELLA, SONJA
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:
Last Name:ALLI-CASELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3218 HONOLULU AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91214-3377
Mailing Address - Country:US
Mailing Address - Phone:818-635-5513
Mailing Address - Fax:
Practice Address - Street 1:3218 HONOLULU AVE APT 4
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91214-3377
Practice Address - Country:US
Practice Address - Phone:818-635-5513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4918712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry