Provider Demographics
NPI:1891230165
Name:HENLEY, CELINA DE LA ROCHA (LAC)
Entity Type:Individual
Prefix:
First Name:CELINA
Middle Name:DE LA ROCHA
Last Name:HENLEY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 W LA HABRA BLVD
Mailing Address - Street 2:APT. 132
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-4349
Mailing Address - Country:US
Mailing Address - Phone:323-528-7232
Mailing Address - Fax:
Practice Address - Street 1:1417 W BEVERLY BLVD
Practice Address - Street 2:102
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4123
Practice Address - Country:US
Practice Address - Phone:323-528-7232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17140171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist