Healthcare Provider Details

I. General information

NPI: 1124173786
Provider Name (Legal Business Name): MARIO CELAYA P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 SEQUOIA AVE STE B
LINDSAY CA
93247-1424
US

IV. Provider business mailing address

833 SEQUOIA AVE
LINDSAY CA
93247-1424
US

V. Phone/Fax

Practice location:
  • Phone: 559-562-1361
  • Fax:
Mailing address:
  • Phone: 559-562-1361
  • Fax: 559-789-9828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13774
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: