Provider Demographics
NPI:1649417411
Name:VERGARA, CELESTE T (PT)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:T
Last Name:VERGARA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:18700 BEACH BLVD
Mailing Address - Street 2:120
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-2030
Mailing Address - Country:US
Mailing Address - Phone:714-962-6760
Mailing Address - Fax:714-962-5961
Practice Address - Street 1:18700 BEACH BLVD
Practice Address - Street 2:120
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2030
Practice Address - Country:US
Practice Address - Phone:714-962-6760
Practice Address - Fax:714-962-5961
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPT 35311225100000X
CA353112251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist