Provider Demographics
NPI:1124855390
Name:CEBALLOS, NATHALY ABIGAIL
Entity type:Individual
Prefix:
First Name:NATHALY
Middle Name:ABIGAIL
Last Name:CEBALLOS
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 1:150 S LOS ROBLES AVE STE 950
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2474
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2505 HANCOCK ST APT 104
Practice Address - Street 2:
Practice Address - City:LINCOLN HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:90031-1757
Practice Address - Country:US
Practice Address - Phone:626-826-0094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician