Provider Demographics
NPI:1609350669
Name:EDGAR CELIS MD INC
Entity Type:Organization
Organization Name:EDGAR CELIS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:
Authorized Official - Last Name:CELIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-372-3673
Mailing Address - Street 1:1050 NORTHGATE DR STE 460
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2542
Mailing Address - Country:US
Mailing Address - Phone:415-306-7641
Mailing Address - Fax:415-526-3734
Practice Address - Street 1:1050 NORTHGATE DR STE 460
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2542
Practice Address - Country:US
Practice Address - Phone:415-306-7641
Practice Address - Fax:415-526-3734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Single Specialty