Healthcare Provider Details

I. General information

NPI: 1558138263
Provider Name (Legal Business Name): CELESTE GONZALEZ MAYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12791 NEWPORT AVE STE 101
TUSTIN CA
92780-2785
US

IV. Provider business mailing address

327 W 18TH ST
SANTA ANA CA
92706-2601
US

V. Phone/Fax

Practice location:
  • Phone: 714-731-6549
  • Fax: 714-731-6549
Mailing address:
  • Phone: 619-865-2512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHT10597
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: