Healthcare Provider Details

I. General information

NPI: 1346178654
Provider Name (Legal Business Name): CELESTINE NDOSIRI MUMAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2721 SOHO LN
FAIRFIELD CA
94533-6645
US

IV. Provider business mailing address

2721 SOHO LN
FAIRFIELD CA
94533-6645
US

V. Phone/Fax

Practice location:
  • Phone: 510-280-4567
  • Fax:
Mailing address:
  • Phone: 510-280-4567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number233238
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: