=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255192407
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. CELESTIN VEGAS VASCULAR MEDICINE, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2024
-----------------------------------------------------
Last Update Date | 01/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8905 W POST RD STE 110
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89148-2429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-827-2362
-----------------------------------------------------
Fax | 877-827-2362
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8905 W POST RD STE 110
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89148-2429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-827-2362
-----------------------------------------------------
Fax | 877-827-2362
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/OWNER
-----------------------------------------------------
Name | CARMEL AUDREY CELESTIN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 877-827-2362
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246XC2903X
-----------------------------------------------------
Taxonomy Name | Vascular Specialist/Technologist Cardiovascular
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------