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General NPI Number Information
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NPI Number | 1154283695
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Entity Type | Individual
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Provider Name | SANDRA LETICIA CELIS-REID FNP
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Gender | Female
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Dates
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Enumeration Date | 12/02/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 1600 PROVIDENCE DR
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City | WACO
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State | TX
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Zip | 76707-2261
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Country | US
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Telephone | 254-313-4974
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Fax |
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Provider Business Mailing Address
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Address Line | 1903 AGATE DR
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City | KILLEEN
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State | TX
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Zip | 76549-4917
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Country | US
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Telephone | 254-423-5732
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1216523
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License Number State | TX
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