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General NPI Number Information
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NPI Number | 1609350669
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Entity Type | Organization
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Legal Business Name | EDGAR CELIS MD INC
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Dates
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Enumeration Date | 09/17/2018
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Last Update Date | 09/17/2018
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Provider Practice Location Address
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Address Line | 1050 NORTHGATE DR STE 460
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City | SAN RAFAEL
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State | CA
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Zip | 94903-2542
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Country | US
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Telephone | 415-306-7641
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Fax | 415-526-3734
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Provider Business Mailing Address
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Address Line | 1050 NORTHGATE DR STE 460
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City | SAN RAFAEL
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State | CA
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Zip | 94903-2542
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Country | US
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Telephone | 415-306-7641
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Fax | 415-526-3734
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Authorized Official
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Title or Position | OWNER
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Name | EDGAR CELIS
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Credential | MD
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Telephone | 617-372-3673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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