Healthcare Provider Details

I. General information

NPI: 1164703393
Provider Name (Legal Business Name): CELIA MARIE VACLAVIK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27150 HIGHWAY 290 STE 100
CYPRESS TX
77433-7224
US

IV. Provider business mailing address

27150 HIGHWAY 290 STE 100
CYPRESS TX
77433-7224
US

V. Phone/Fax

Practice location:
  • Phone: 832-653-3300
  • Fax: 832-653-6407
Mailing address:
  • Phone: 832-653-3300
  • Fax: 832-653-6407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA07503
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: