Provider Demographics
NPI:1710637095
Name:MUMAR, CECILIA R
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:R
Last Name:MUMAR
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 1:1023 N HOLLYWOOD WAY STE 207
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-2543
Mailing Address - Country:US
Mailing Address - Phone:818-588-3102
Mailing Address - Fax:818-337-2920
Practice Address - Street 1:1023 N HOLLYWOOD WAY STE 207
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-2543
Practice Address - Country:US
Practice Address - Phone:818-588-3102
Practice Address - Fax:818-337-2920
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide