Provider Demographics
NPI:1093387326
Name:LE, CELESTA
Entity Type:Individual
Prefix:
First Name:CELESTA
Middle Name:
Last Name:LE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35325 DATE PALM DR STE 143
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-7031
Mailing Address - Country:US
Mailing Address - Phone:760-202-4308
Mailing Address - Fax:
Practice Address - Street 1:6700 INDIANA AVE STE 252
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4264
Practice Address - Country:US
Practice Address - Phone:760-202-4308
Practice Address - Fax:760-818-8025
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL9655174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist