Healthcare Provider Details

I. General information

NPI: 1083128607
Provider Name (Legal Business Name): P CELESTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2017
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 E LOHMAN AVE STE 112
LAS CRUCES NM
88001
US

IV. Provider business mailing address

2001 E LOHMAN AVE STE 112
LAS CRUCES NM
88001-3198
US

V. Phone/Fax

Practice location:
  • Phone: 575-232-9022
  • Fax: 575-288-2701
Mailing address:
  • Phone: 575-232-9022
  • Fax: 575-288-2701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number0897
License Number StateNM

VIII. Authorized Official

Name: MS. PAULA CELESTE ROGERS
Title or Position: PRESIDENT/OWNER
Credential: BC-HIS
Phone: 575-232-9022