Provider Demographics
NPI:1851138465
Name:GOLLIHER, CECILIA MARIE (FNP-BC)
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:MARIE
Last Name:GOLLIHER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:CECILIA
Other - Middle Name:MARIE
Other - Last Name:MENDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1055 LINCOLN BLVD APT 5
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4015
Mailing Address - Country:US
Mailing Address - Phone:626-617-0435
Mailing Address - Fax:
Practice Address - Street 1:700 TIVERTON DRIVE FACTOR BUILDING
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-825-1702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2032489363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily