Healthcare Provider Details

I. General information

NPI: 1194036822
Provider Name (Legal Business Name): CELINDA SOPHIE EADS CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 06/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 W VALLEY PKWY
ESCONDIDO CA
92025-2559
US

IV. Provider business mailing address

2003 SAN PASQUAL CT
LEMON GROVE CA
91945-3640
US

V. Phone/Fax

Practice location:
  • Phone: 760-747-3529
  • Fax:
Mailing address:
  • Phone: 760-458-3972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1030
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: