Healthcare Provider Details

I. General information

NPI: 1326349754
Provider Name (Legal Business Name): CELESTE RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 POPLAR ST APT 216
ANTHONY TX
79821-7313
US

IV. Provider business mailing address

225 POPLAR ST APT 216
ANTHONY TX
79821-7313
US

V. Phone/Fax

Practice location:
  • Phone: 915-204-7908
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number103K00000X
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: