Provider Demographics
NPI:1568172252
Name:CELEBRITY MEDICAL SPA
Entity Type:Organization
Organization Name:CELEBRITY MEDICAL SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:503-430-0944
Mailing Address - Street 1:12325 SW HORIZON BLVD STE 35
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-9474
Mailing Address - Country:US
Mailing Address - Phone:503-430-0944
Mailing Address - Fax:
Practice Address - Street 1:12325 SW HORIZON BLVD STE 35
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-9474
Practice Address - Country:US
Practice Address - Phone:503-430-0944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center