Provider Demographics
NPI:1194036822
Name:EADS, CELINDA SOPHIE (CMT)
Entity Type:Individual
Prefix:
First Name:CELINDA
Middle Name:SOPHIE
Last Name:EADS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 SAN PASQUAL CT
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-3640
Mailing Address - Country:US
Mailing Address - Phone:760-458-3972
Mailing Address - Fax:
Practice Address - Street 1:1118 W VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-2559
Practice Address - Country:US
Practice Address - Phone:760-747-3529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1030174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist