Provider Demographics
NPI:1790198653
Name:CARBAJAL, FELICIA I
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:CARBAJAL
Suffix:I
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 1:1600 N SAN FERNANDO BLVD
Mailing Address - Street 2:APT #335
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-4156
Mailing Address - Country:US
Mailing Address - Phone:818-669-2355
Mailing Address - Fax:
Practice Address - Street 1:13001 RAMONA BLVD
Practice Address - Street 2:STE. I
Practice Address - City:IRWINDALE
Practice Address - State:CA
Practice Address - Zip Code:91706-3752
Practice Address - Country:US
Practice Address - Phone:626-337-3828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner