Provider Demographics
NPI:1558138263
Name:MAYA, CELESTE GONZALEZ
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:GONZALEZ
Last Name:MAYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2601
Mailing Address - Country:US
Mailing Address - Phone:619-865-2512
Mailing Address - Fax:
Practice Address - Street 1:12791 NEWPORT AVE STE 101
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2785
Practice Address - Country:US
Practice Address - Phone:714-731-6549
Practice Address - Fax:714-731-6549
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHT10597237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist