Healthcare Provider Details

I. General information

NPI: 1053194175
Provider Name (Legal Business Name): MARIA GUADALUPE CELEDON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 LAS TABLAS RD
TEMPLETON CA
93465-9758
US

IV. Provider business mailing address

2050 S BLOSSER RD
SANTA MARIA CA
93458-7310
US

V. Phone/Fax

Practice location:
  • Phone: 805-542-6700
  • Fax: 805-542-6791
Mailing address:
  • Phone: 805-346-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number65057
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: