Healthcare Provider Details

I. General information

NPI: 1801426903
Provider Name (Legal Business Name): CELESTINE COLLINS PCA/ M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2020
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3370 S PECOS RD
LAS VEGAS NV
89121-3747
US

IV. Provider business mailing address

3370 S PECOS RD
LAS VEGAS NV
89121-3747
US

V. Phone/Fax

Practice location:
  • Phone: 702-689-1508
  • Fax:
Mailing address:
  • Phone: 702-689-1508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number770428778
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number770428778
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: