Provider Demographics
NPI:1508219023
Name:CELERIAN, ALEXA NICOLE REYES (DO)
Entity Type:Individual
Prefix:MS
First Name:ALEXA NICOLE
Middle Name:REYES
Last Name:CELERIAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 E KINCAID ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4127
Mailing Address - Country:US
Mailing Address - Phone:360-814-6451
Mailing Address - Fax:360-445-8592
Practice Address - Street 1:1801 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4632
Practice Address - Country:US
Practice Address - Phone:360-424-4410
Practice Address - Fax:360-424-0749
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAOP61058984207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program