Provider Demographics
NPI:1417752122
Name:CARMONA, JANELL
Entity type:Individual
Prefix:
First Name:JANELL
Middle Name:
Last Name:CARMONA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 MILLBURY AVE
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91746-1035
Mailing Address - Country:US
Mailing Address - Phone:626-622-2839
Mailing Address - Fax:
Practice Address - Street 1:3634 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-3471
Practice Address - Country:US
Practice Address - Phone:626-660-9587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician