Provider Demographics
NPI:1114501053
Name:VILLALOBOS, CELESTE (RDH)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:
Last Name:VILLALOBOS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5527 ARMSLEY ST
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2003
Mailing Address - Country:US
Mailing Address - Phone:909-966-7323
Mailing Address - Fax:
Practice Address - Street 1:2060 E ROUTE 66 STE 105
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4691
Practice Address - Country:US
Practice Address - Phone:626-594-0374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32647124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA19083003OtherREGISTERED DENTAL HYGIENIST