Healthcare Provider Details

I. General information

NPI: 1689244618
Provider Name (Legal Business Name): CELESTE ANN ALBANEZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4640 ADMIRALTY WAY
MARINA DEL REY CA
90292-6621
US

IV. Provider business mailing address

100 PROSPECTOR CT
FOLSOM CA
95630-5119
US

V. Phone/Fax

Practice location:
  • Phone: 888-880-3451
  • Fax:
Mailing address:
  • Phone: 916-600-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95015764
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: