Healthcare Provider Details

I. General information

NPI: 1790149953
Provider Name (Legal Business Name): CELESTE ROVITO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 05/24/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19401 HUBBARD DR JAMESON HOSPITAL
DEARBORN MI
48126-2641
US

IV. Provider business mailing address

212 SNOWBERRY CIR JAMESON HOSPITAL
VENETIA PA
15367-1042
US

V. Phone/Fax

Practice location:
  • Phone: 313-982-8100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA058103
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: