Healthcare Provider Details

I. General information

NPI: 1407723273
Provider Name (Legal Business Name): CELESTINA MEDINA L.M.T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2025
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 MANKIN ST NE
ALBUQUERQUE NM
87123-1125
US

IV. Provider business mailing address

440 MANKIN ST NE
ALBUQUERQUE NM
87123-1125
US

V. Phone/Fax

Practice location:
  • Phone: 505-267-8812
  • Fax:
Mailing address:
  • Phone: 505-267-8812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT9095
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: