Provider Demographics
NPI:1558654053
Name:GESMUNDO, CELSIUS-KIT JARA (MD)
Entity Type:Individual
Prefix:DR
First Name:CELSIUS-KIT
Middle Name:JARA
Last Name:GESMUNDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CELSIUS
Other - Middle Name:JARA
Other - Last Name:GESMUNDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1150 GRAHAM RD STE 101
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-8077
Mailing Address - Country:US
Mailing Address - Phone:314-206-3900
Mailing Address - Fax:
Practice Address - Street 1:1150 GRAHAM RD STE 101
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8077
Practice Address - Country:US
Practice Address - Phone:314-206-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ501872084P0800X
390200000X
MO20190099172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program