Healthcare Provider Details

I. General information

NPI: 1902072044
Provider Name (Legal Business Name): RENE CELIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 MEMORIAL MEDICAL PKWY STE 200
DAYTONA BEACH FL
32117-5672
US

IV. Provider business mailing address

103 MEMORIAL MEDICAL PKWY STE 200
DAYTONA BEACH FL
32117-5672
US

V. Phone/Fax

Practice location:
  • Phone: 386-615-1521
  • Fax: 386-671-0694
Mailing address:
  • Phone: 386-615-1521
  • Fax: 386-671-0694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME 123422
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberBP10031983
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME 123422
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: