Provider Demographics
NPI:1114339652
Name:CELAYA, MAGDA (MD)
Entity Type:Individual
Prefix:
First Name:MAGDA
Middle Name:
Last Name:CELAYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5896 SW 16TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-2105
Mailing Address - Country:US
Mailing Address - Phone:305-262-0203
Mailing Address - Fax:
Practice Address - Street 1:5000 UNIVERSITY DRIVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2094
Practice Address - Country:US
Practice Address - Phone:786-308-3730
Practice Address - Fax:786-308-3738
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0040798208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0670910-00Medicaid
FLME0040798OtherMEDICAL LICENSE
FLME0040798OtherMEDICAL LICENSE