Healthcare Provider Details

I. General information

NPI: 1457141533
Provider Name (Legal Business Name): CELESTE JIJON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 E 120TH ST
LOS ANGELES CA
90059-3026
US

IV. Provider business mailing address

2200 JOHN MUIR PKWY
HERCULES CA
94547-2803
US

V. Phone/Fax

Practice location:
  • Phone: 424-338-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number95269404
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: