MEDICARE: CELINE MEDICAL SPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1457210841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CELINE MEDICAL SPA

Provider Business Mailing Address
First Line	:	5168 VILLAGE CREEK DR STE 300
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-4447
Country	:	US
Telephone Number	:	214-789-2096
Fax Number	:	214-382-0039

Provider Business Practice Location Address
First Line	:	5168 VILLAGE CREEK DR STE 300
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-4447
Country	:	US
Telephone Number	:	214-789-2096
Fax Number	:	214-382-0039

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JENNIFER CHAE
Credential	:
Telephone Number	:	972-750-6100

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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Directions to “CELINE MEDICAL SPA ” Practice Location

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