Provider Demographics
NPI:1689739161
Name:HERNANDEZ, CELESTINE Q (MD)
Entity Type:Individual
Prefix:
First Name:CELESTINE
Middle Name:Q
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1995 ERRECART BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-8336
Mailing Address - Country:US
Mailing Address - Phone:775-738-3111
Mailing Address - Fax:775-778-6728
Practice Address - Street 1:1995 ERRECART BLVD STE 103
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-8336
Practice Address - Country:US
Practice Address - Phone:775-738-3111
Practice Address - Fax:775-778-6728
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8882208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV8882OtherSTATE LICENSE
NV002004121Medicaid
NVCS09275OtherSTATE PHARMACY
NVCS09275OtherSTATE PHARMACY
NV8882OtherSTATE LICENSE