Provider Demographics
NPI:1639462815
Name:LO, CELEDONIA (RN)
Entity Type:Individual
Prefix:
First Name:CELEDONIA
Middle Name:
Last Name:LO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:957 WIND CAVE PL
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-3613
Mailing Address - Country:US
Mailing Address - Phone:856-723-7296
Mailing Address - Fax:
Practice Address - Street 1:957 WIND CAVE PL
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-3613
Practice Address - Country:US
Practice Address - Phone:856-723-7296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO10134700163WP0808X
CA651097163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health