Provider Demographics
NPI:1073664223
Name:CELAYA, DELISA A (DDS)
Entity Type:Individual
Prefix:DR
First Name:DELISA
Middle Name:A
Last Name:CELAYA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 N SAN DIMAS AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-2658
Mailing Address - Country:US
Mailing Address - Phone:909-599-5123
Mailing Address - Fax:909-592-1903
Practice Address - Street 1:319 N SAN DIMAS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2658
Practice Address - Country:US
Practice Address - Phone:909-599-5123
Practice Address - Fax:909-592-1903
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice