Provider Demographics
NPI:1215592423
Name:CELESTIN-RIVIERE, MARIE MAROLAINE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:MAROLAINE
Last Name:CELESTIN-RIVIERE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23323 KEY LARGO LOOP
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-6742
Mailing Address - Country:US
Mailing Address - Phone:813-326-5559
Mailing Address - Fax:
Practice Address - Street 1:23323 KEY LARGO LOOP
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-6742
Practice Address - Country:US
Practice Address - Phone:813-326-5559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities