Healthcare Provider Details

I. General information

NPI: 1750860060
Provider Name (Legal Business Name): CELESTE MARTINEZ DE LUNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3845 SPRING DR
SPRING VALLEY CA
91977-1030
US

IV. Provider business mailing address

2130 NATIONAL AVE
SAN DIEGO CA
92113-2209
US

V. Phone/Fax

Practice location:
  • Phone: 619-255-5182
  • Fax:
Mailing address:
  • Phone: 619-255-7876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: