Provider Demographics
NPI:1467888446
Name:JONGUITUD, CELINA HERNANDEZ (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CELINA
Middle Name:HERNANDEZ
Last Name:JONGUITUD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3314 S 92ND DR
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-5544
Mailing Address - Country:US
Mailing Address - Phone:623-986-2096
Mailing Address - Fax:
Practice Address - Street 1:3314 S 92ND DR
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-5544
Practice Address - Country:US
Practice Address - Phone:623-986-2096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP046719164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse