Healthcare Provider Details

I. General information

NPI: 1336152396
Provider Name (Legal Business Name): CELEDOR HUTTO AKINTUNDE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CELEDOR HUTTO BOND MD

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 BIRCH ALY
BEAVERCREEK OH
45440-1479
US

IV. Provider business mailing address

2960 CAMINO DIABLO STE 105
WALNUT CREEK CA
94597-3945
US

V. Phone/Fax

Practice location:
  • Phone: 800-892-2695
  • Fax: 415-458-2691
Mailing address:
  • Phone: 800-892-2695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number2021-02486
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number35.123232
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: