Provider Demographics
NPI:1316207012
Name:VILLEGAS, CELESTE (LAC)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:
Last Name:VILLEGAS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 W VICTORIA ST
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-4945
Mailing Address - Country:US
Mailing Address - Phone:832-693-0233
Mailing Address - Fax:
Practice Address - Street 1:112 E OLIVE AVE
Practice Address - Street 2:STE. C
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5281
Practice Address - Country:US
Practice Address - Phone:909-792-1003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 14581171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist