Healthcare Provider Details

I. General information

NPI: 1982581617
Provider Name (Legal Business Name): CELESTINO JUAN MELCHOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11429 VALLEY BLVD
EL MONTE CA
91731-3229
US

IV. Provider business mailing address

25000 HAWKBRYN AVE SPC 9
NEWHALL CA
91321-5837
US

V. Phone/Fax

Practice location:
  • Phone: 626-993-3000
  • Fax:
Mailing address:
  • Phone: 323-561-8799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: