Healthcare Provider Details

I. General information

NPI: 1164186789
Provider Name (Legal Business Name): CELIA ANAY ALVARADO ACEVEDO RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2021
Last Update Date: 10/29/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 S GOODWIN RD.
LONE PINE CA
93545
US

IV. Provider business mailing address

250 N SEE VEE LN
BISHOP CA
93514-8130
US

V. Phone/Fax

Practice location:
  • Phone: 760-876-4795
  • Fax: 760-503-4174
Mailing address:
  • Phone: 760-873-8464
  • Fax: 760-503-4174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number32706
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: