Provider Demographics
NPI:1437395357
Name:CELESTE LIM AMAYA MD MEDICAL CORPORATION
Entity Type:Organization
Organization Name:CELESTE LIM AMAYA MD MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:L
Authorized Official - Last Name:AMAYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-346-7791
Mailing Address - Street 1:74000 COUNTRY CLUB DR
Mailing Address - Street 2:STE J-1
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-1685
Mailing Address - Country:US
Mailing Address - Phone:760-346-7791
Mailing Address - Fax:760-341-5953
Practice Address - Street 1:74000 COUNTRY CLUB DR
Practice Address - Street 2:STE J-1
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-1685
Practice Address - Country:US
Practice Address - Phone:760-346-7791
Practice Address - Fax:760-341-5953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68073207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABC714AMedicare PIN