Provider Demographics
NPI:1780673426
Name:CELNIK, DAVID (DPH)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CELNIK
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12925 MAGNOLIA BLVD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-1618
Mailing Address - Country:US
Mailing Address - Phone:818-783-6100
Mailing Address - Fax:818-783-9780
Practice Address - Street 1:12925 MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-1618
Practice Address - Country:US
Practice Address - Phone:818-783-6100
Practice Address - Fax:818-783-9780
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27778183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0574079OtherNABP
CAPHA221410OtherMEDI-CAL