Provider Demographics
NPI:1326535923
Name:CELESTIN, FABIENDO
Entity Type:Individual
Prefix:MR
First Name:FABIENDO
Middle Name:
Last Name:CELESTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 CANAL ST. 6W STE 9
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840-1454
Mailing Address - Country:US
Mailing Address - Phone:857-269-5284
Mailing Address - Fax:
Practice Address - Street 1:599 CANAL ST 6W STE 9
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-0184
Practice Address - Country:US
Practice Address - Phone:857-269-5284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-18
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)