Provider Demographics
NPI:1164703393
Name:VACLAVIK, CELIA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:CELIA
Middle Name:MARIE
Last Name:VACLAVIK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 ASHLAND ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-2418
Mailing Address - Country:US
Mailing Address - Phone:713-864-2659
Mailing Address - Fax:713-864-5577
Practice Address - Street 1:16620 N US HIGHWAY 281
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-2327
Practice Address - Country:US
Practice Address - Phone:210-269-4618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07503363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant