Provider Demographics
NPI:1235741752
Name:SIASAT, CELENA RACQUEL
Entity Type:Individual
Prefix:MRS
First Name:CELENA
Middle Name:RACQUEL
Last Name:SIASAT
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 1:2814 W MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-2748
Mailing Address - Country:US
Mailing Address - Phone:323-758-5433
Mailing Address - Fax:800-750-7204
Practice Address - Street 1:2814 W MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-2748
Practice Address - Country:US
Practice Address - Phone:323-758-5433
Practice Address - Fax:800-750-7204
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program