Provider Demographics
NPI:1346522208
Name:ABRIZ, CELESTIAL GABRIEL
Entity Type:Individual
Prefix:MS
First Name:CELESTIAL
Middle Name:GABRIEL
Last Name:ABRIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:CELESTIAL
Other - Middle Name:GABRIEL
Other - Last Name:BANDOY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:82900 AVENUE 42
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92203-9658
Mailing Address - Country:US
Mailing Address - Phone:760-347-3254
Mailing Address - Fax:
Practice Address - Street 1:82900 AVENUE 42
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92203
Practice Address - Country:US
Practice Address - Phone:760-347-3254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63580183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist