Healthcare Provider Details

I. General information

NPI: 1861173882
Provider Name (Legal Business Name): CELESTE CISNEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 07/31/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 2ND AVE SW
ALBANY OR
97321-2482
US

IV. Provider business mailing address

680 HANSEN CT
DIXON CA
95620-2471
US

V. Phone/Fax

Practice location:
  • Phone: 503-751-3048
  • Fax:
Mailing address:
  • Phone: 530-375-0166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: