Provider Demographics
NPI:1215195664
Name:DURU, CELESTINA (DPM)
Entity Type:Individual
Prefix:MISS
First Name:CELESTINA
Middle Name:
Last Name:DURU
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 MELBOURNE RD
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-6318
Mailing Address - Country:US
Mailing Address - Phone:972-790-2800
Mailing Address - Fax:972-790-2803
Practice Address - Street 1:117 MELBOURNE RD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-6318
Practice Address - Country:US
Practice Address - Phone:972-790-2800
Practice Address - Fax:972-790-2803
Is Sole Proprietor?:No
Enumeration Date:2008-05-31
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1903213ES0103X
222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX206616902Medicaid